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AC OOR" CERTIFICATE OF LIABILITY INSURANCE
�•-�-•�
DATE(MMIDDIYYYY)
F 09/25/2023
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 pollcy(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
DMP Equine Insurance Services
CONTACT Donna M. Parker
NAME:
AACNNo Ext • (877)457-7734 (ASC, No); (828)594-8885
206 Martindale Way
Glendora, CA 91741
E-MAIL
ADDRESS:
_ .._donna@DMPEquine-ins.com _
INSURERS AFFORDING COVERAGE NAIC #
License #: 3002567078
INSURERA: Great American Insurance Group
DAMAGE TO RETED
PREMISES (Ea occurrence) ) $ 100,000
INSURED
INSURER B
Judy Klus
95740 FERGUSON RANCH ROAD
GOLD BEACH, OR 97444
INSURERC:
INSURER D :
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00001848-44049 REVISION NUMBER: 2
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
(MMIDD/YYYYI
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I OCCUR
Y
F069249
08/23/2023
08/23/2024
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RETED
PREMISES (Ea occurrence) ) $ 100,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEML AGGREGATE LIMIT APPLIES PER:
X POLICY D JEC LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
$
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
COMBINED SINGLE LIMIT $
Ea accident
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
Per accident $
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE —]NIA
OFFICER/MEMBER EXCLUDED
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
PER OTH-
STATUTE I I ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYE $
E.L. DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Town of Los Altos
26379 Fremont Road
Los Altos, CA 94022
ACORD 25 (2016/03)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD Printed by DMP on 09/25/2023 at 11:57AM