HomeMy WebLinkAboutComcast (6)Ac<>R" CERTIFICATE OF LIABILITY INSURANCE
DATE 12/18//20192019 IYYYY)
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 Street
Philadelphia, PA 19103-2797
AUn: Comcast.Certs@marsh.com Fax: 212-948-0360
CONTACT
NAME:
FAX
A/CONE. o Ext); :77771AIC No):
E-MAIL
INSURERS AFFORDING COVERAGE NAIC #
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE L X� OCCUR
INSURER A : ACE American Insurance Company 22667
INSURED COMCAST OF CALIFORNRICH IO/PEN NSYLVANIA/
INSURER B : Indemnity Ins Co Of North America 43575
INSURER C: ACE Propeqy And Casualty Ins Co 20699
UTAH/WASHINGTON, INC.
12647 ALCOSTA BLVD., SUITE 200
P0. BOX 5147
INSURER D : ACE Fire Underwriters Ins. Co. 20702
INSURER E:
SAN RAMON, CA 94583
INSURER F:
SIR: $100,000 _
COVERAGES CERTIFICATE NUMBER: CLE -005483068-21 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. NOTWIT1]STANDING .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.
INSR
LTR
TYPE OF INSURANCE
ADDL.
INSD
§U9f:
WVQ
POLICY NUMBERMM/DD/YYYY
POLICY EFF
POLICY EXP
MM/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE L X� OCCUR
XSLG7144756A
12/01/2019
12/01/202.0
EACH OCCURRENCE $ 9,900,000
DAMAGE TO RENTED
PREMISES Ea occurrence) $ 9,900,000
MED EXP (Any one person) $ 10,000
X
SIR: $100,000 _
PERSONAL & ADV INJURY $ 9,9007000
AGGREGATE LIMIT APPLIES PER:
POLICY ❑ PRO JECT LOC
GENERAL AGGREGATE $ 40,000,000
GENT
X
PRODUCTS - COMP/OP AGG $ 10,000,000
$
OTHER _
A
AUTOMOBILE
LIABILITY
ISAH25285438
12/01/2019
12/01/2020
COMBINED SINGLE LIMIT $ 10,000,000
(Ea accident)
X
ANY AUTO
BODILY INJURY (Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident) $
HIRED F NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
(Per accident) $
$
X
UMBRELLA LIAB
X
OCCUR
X00 G27924840 005
12/01/2019
12/01/2020
EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
EXCESS LIAB _
CLAIMS -MADE
DED RETENTION .,—,—_
$
_
_
B
A
D
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y N
AND EMPL IE ERS' AABILIT EXECUTIVE
OFFICER/MEMBEREXCLUDED? CN I
(Mandatory in NH)
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 DTH -
_ 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY POLICY AND AUTOMOBILE LIABILITY POLICY WHERE REQUIRED BY WRITTEN CONTRACT
WITH THE NAMED INSURED.
CERTIFICATE HOLDER CANCELLATION
TOWN OF LOS ALTOS HILLS, CALIFORNIA
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 (2016/03) The ACORD name and logo are registered marks of ACORD
0002101 SP 0731-C01-P02102-1
TOWN OF LOS ALTOS HILLS, CALIFORNIA
ATTN: CITY MANAGER
26379 FREEMONT ROAD
LOS ALTOS HILLS, CA 94022