HomeMy WebLinkAboutComcast (5)Ae6R"+a'CERTIFICATE OF LIABILITY INSURANCE
D12/18/2019D/vyyv)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
MARSH USA INC.
1717 Arch StreetA/C.
CONTACT
NAME'
PHONE FAX
No. EMU: IA/C, No):
Philadelphia, PA 19103-2797
Attn: Comcast.Certs@marsh.com Fax: 212-948-0360
E-MAIL
ADDRESS:
_
INSURER(S) AFFORDING COVERAGE
NAIC #
EACH OCCURRENCE $ 9,900,000
INSURER A: ACE American Insurance Company
22667
INSURED
COMCAST OF CALIFORNIA/OHIOIPENNSYLVANIA/—
INSURER B : IndemnityIns Co Of North America
43575
INSURER C : ACE Property And Casualty Ins Co
-
20699
UTAH/WASHINGTON, INC.
12647 ALCOSTA BLVD., SUITE 200
P.O. BOX 5147
INSURER D : ACE Fire Underwriters Ins. Co.
20702
—
INSURER E:
ISAH25285438
SAN RAMON, CA 94583
INSURER F:
COMBINED SINGLE LIMIT $ 10,000,000
Ea accident
BODILY INJURY (Per person) $
COVERAGES CERTIFICATE NUMBER: CLE -005483718-23 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSRTYPE
LTR
OF INSURANCE
__,�,
ADDL
SUER
POLICY NUMBER
EFF
MM/DD YYYY
POLICYY
Y
M DD YYY
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
' "I OCCUR
X SIR: $100,000 _ _
of Marsh USA Inc.
XSLG7144756A
1210112019
12/01/2020
EACH OCCURRENCE $ 9,900,000
DAMAGE TCLAIMS-MADE nce) $ 9,900,000
PREM SESO(Ea occurRETEre
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 9,900,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X IIL�_J PRO L LOC
JECT
OTHER:
GENERAL AGGREGATE $ 40,000,000
10,000,000POLICY
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
ISAH25285438
12/01/2019
12/01/2020
COMBINED SINGLE LIMIT $ 10,000,000
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
Per accident
X
UMBRELLALIAB
EXCESS LIAR
X
OCCl1R
CLAIMS -MADE
XOO G27924840 005
12/0112019
12/01/2020
EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
DED RETENTION $
$
B
A
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIE"TOR/PARTNER/EXECUTIVE
(MandaR/MEMNEREXCI_UDED?
(Mandatory in Nil)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WLRC66040677(AOS)
WLRC66040719 CA, MA
( )
SCFC66040793 WI
( )
12/01/2019
12/01/2019
12/01/2020
12/01/2020
12/01/2020
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 2,000,000
E.L. DISEASE - EA EMPLOYEE_ $ 2,000,000
E.L. DISEASE -POLICY LIMIT $ 2,000,000
A
Excess Workers Compensation
WCUC66040756 (WA)
12/01/2019
12/01/2020
Ea Acc/Dis Employee/Dis Polic 2,000,000
SIR 5,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
CERTIFICATE HOLDER CANCELLATION
TOWN OF LOS ALTOS HILLS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN: CITY MANAGER
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
26379 FREEMONT ROAD
ACCORDANCE WITH THE POLICY PROVISIONS.
LOS ALTOS HILLS, CA 94022
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/0.3) The ACORD name and logo are registered marks of ACORD