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HomeMy WebLinkAboutComcast (7)N n v 2 a 7,,, Ac " EP D CERTIFICATE OF LIABILITY INSURANCE L111/ DATE 11/17//20172017 IYYYY) THIS CERTIFICATE IS AFFIRMATIVELY ISSUED AS A MATTER Y AND CONFERS N SET�AI OEBY THE POLICIES DOES NOT OR NEGATVELY AMEND, OR ALTER THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: Ifkhe certificate holder is an ADDITIONAL INSURED, the policy(les) 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 Attn: Comcast.Certs@marsh.com Fax: 212-948-0360 CONTACT NAME: PHON No, Ext): FAX K1.1- o :Philadelphia, E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 1210112017 INSURER A: ACE American Insurance Com an 22667 DAMAGE TO RENTED PREMISES Ea occurrence $ 4,900,000 INSURED COMCAST OF CALIFORNIA/OHIO/PENNSYLVANIA/ INSURER B : Indemnity Ins Co Of North America 43575 INSURER C : ACE Property And Casualty Ins Co 20699 UTAHANASHINGTON, INC. 12647 ALCOSTA BLVD., SUITE 200 P.O. BOX 5147 INSURER D : ACE Fire Underwriters Ins. Co. 20702 INSURER E :Ari General Insurance Company 42757 SAN RAMON, CA 94583 INSURER F : 12/0112017 12/0112018 COVERAGES CERTIFICATE NUMBER: CLE -005483718-21 REVISION NUMRER- 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X SIR: $100,000 of Marsh USA Inc. XSLG27871252 1210112017 12/01/2018 EACH OCCURRENCE $ 4,900,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 4,900,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 4,900,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO JECT LOC OTHER: GENERAL AGGREGATE $ 25,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L ISA H09063407 12/0112017 12/0112018 COMBINED SINGLE LIMIT Ea accident $ 10,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE $ Per accident $ X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE X00 G27924840 003 12/01/2017 12/01/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED I X I RETENTION $ $ B A D E WORKERS COMPENSATION AND EMPLOYERSLIABILITY ' v / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLR C64618933 (AOS) WLR 064618945( CA, MA) SCF WI ( ) WLRC64618969 (TN) 12101/2017 12101/2017 1210112017 12/0112018 12/0112018 1210112018 12/01/2018 X PERSTATUTE ER OTH- 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 WCUC64618970 (WA) 12/0112017 12/01/2018 Ea Acc/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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`»1 ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A'�` "Rp� CERTIFICATE OF LIABILITY INSURANCE FDATE /YYYY) 11/17/2017/2017 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 T gyER4GEy,AFfi Q ED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BET THE ISSUINC�IIER(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 Attn: Comcast.Certs@marsh.com Fax: 212-948-0360 CONTACT NAME: A/C NNo Ext); AIC No ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 XSLG27871252 INSURED COMCAST OF CALIFORNIA/OHIO/PENNSYLVANIA/ INSURER B : Indemnity Ins Co Of North America 43575 INSURER c : ACE Property And Casualty Ins Co 20699 UTAHANASHINGTON, INC. 12647 ALCOSTA BLVD., SUITE 200 P.O. BOX 5147 INSURER D : ACE Fire Underwriters Ins. Co. 20702 INSURER E :Ari General Insurance Company 42757 SAN RAMON, CA 94583 INSURER F: COVERAGES CERTIFICATE NUMBER: CLE -005483068-19 REVISION NIIMRFR- 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR XSLG27871252 12/01/2017 12/01/2018 EACH OCCURRENCE $ 4,900,000 DA AGE TO RENTED PREMISES Ea occurrence $ 4,900,000 X SIR: $100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 4,900,000 GEMLAGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO ❑LOC JECT GENERAL AGGREGATE $ 25,000,000 PRODUCTS - COMP/OP AGG $ 6,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISA H09063407 12/01/2017 12/01/2018 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 NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE (Per accident) $ X UMBRELLA LIAB X OCCUR X00 G27924840 003 12/01/2017 12/01/2018 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE 1-1 DED I X I RETENTION $ $ B A D E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY v / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WLR C64618933 (AOS) WLR 064618945 CA, MA ( ) SCF 064618957 (WI) WLRC64618969 (TN) 12/01/2017 12/01/2017 12/01/2017 12/01/2018 12/0112018 12/01/2018 12/01/2018 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 WCUC64618970 (WA) 12/01/2017 12/01/2018 Ea Ace/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 PO FlPRS+R�QU�R D,�Ys V ITTEN CONTRACT WITH THE NAMED INSURED.") _ .I :' Etta NOV 2 8 ?p11 ,, CERTIFICATE HOLDER CANCELLATION ` "" mot I -VO MLIV) Hil I 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