HomeMy WebLinkAboutComcast (10)AC"R" CERTIFICATE ®F LIABILITY INSURANCE
D11120/20180/YYYY)
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(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. E
1717 Arch Street R
R
CONTACT
NAME'
AX
PHCN o t • A/C,
/C No):
Philadelphia, PA 19103-2797
Attn: Comcast.Certs@marsh.com Fax: 212-948-0360n
®3' 2018
EMAIL
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC#
INSURER A: ACE American Insurance Company 22667
12101/2019
INSURED
COMCAST OF CALIFORNIA/OHIO/PENNSYLVANIA/ W
I URER B : IndemnityIns Co Of North America 43575
RER C: ACE Property And Casualty Ins Cc 20699
UTAHMASHINGTON, INC, `��� Irl I H
lV��I\' �4�
12647 ALCOSTA BLVD., SUITE 200
P.O. BOX 5147
INSURER D : ACE Fire Underwriters Ins. Co. 20702
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY 0 PRO JECT ❑ LOC
OTHER:
SAN RAMON, CA 94583
INSURER E:
INSURER F,:
A
COVERAGES CERTIFICATE NUMBER: CLE -005483718-22 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.
INSR
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
SIR: $100,000
Manashi Mukherjeert Wit,: ate,
XSLG71209313
12101/2018
12101/2019
EACH OCCURRENCE $ 4,900,000
DAMAGE TO RENTED
PREMISES Ea occurrence $ 4,900,000
X
MED EXP (Any one person) $ 10,000
PERSONAL&ADV INJURY $ 4,900,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY 0 PRO JECT ❑ LOC
OTHER:
GENERALAGGREGATE $ 25,000,000
PRODUCTS - COMP/OP AGG $ 6,000,N000
$
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
r
ISA H25275354
12101/2018
12/01/2019
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
OCCUR
CLAIMS -MADE
X00 G27924840 004
1210112018
F/2
EACH OCCURRENCE $ 10,000,000
AGGREGATE $ 10,000,000
DED X RETENTION $
$
B
A
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? �
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WLR C65440398 (AOS)
WLR C6544043A CA, MA
( )
SCF C65440519 WI
( )
1210112018
12/0112018
1210112019
X STATUTE �RH
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
WCUC65440477 (WA)
1210112018
12/01/2019
Ea Acc/Dis Employee/Dis Po lic 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 Mukherjeert Wit,: ate,
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD