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HomeMy WebLinkAboutCertificate of Insurance (3)r;l AnrZnv_n1 \/QI IN(:A ACS JRL?� CERTIFICATE OF LIABILITY INSURANCE DATE 10/118/28/2102233 10 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 License # 0757776 HUB International Insurance Services Inc. PO Box 5345 Riverside, CA 92517 coNTACT Victoria Bauders NAME: PHONE FAX (A/c, No, Ext): (AIC, No): (951) 231-2572 AOMORIESS: cal.cpu@hubinternational.com INSURERS AFFORDING COVERAGE NAIC # A INSURER A: Sentinel Insurance Company, Ltd. 11000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR INSURED INSURERS: Hartford Accident and Indemnity Company 22357 INSURER C: Hartford Casualty Insurance Company 29424 Gladwell Governmental Services, Inc. INSURER D: United States LiabilityInsurance 25895 P.O. Box 62 Lake Arrowhead, CA 92352 INSURER E: INSURER F: COVERAGES CFRTIFICATF NIIMRFR- RFVICInm M"FullaGQ• 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 R TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF M DD POLICY EXP D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR X 72SBAIB5623 10/31/2023 10/31/2024 EACH OCCURRENCE $ 1,000,000 DAMAGET REMISS aTEDoccurrence) 1,000,000 MED EXP (Any one erson 10'000 PERSONAL & ADV INJURY 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ®jE LOC GENERAL AGGREGATE $ 2,000,000 GEN'L PRODUCTS - COMP/OP AGG 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY Perperson) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 72UECPT0490 10/31/2023 10/31/2024 BODILY INJURY Per accident $ Pe�accldentDAMAGE �p AUTOS ONLY ATOS ONNLY UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICERIMEMBE�EXCLUDED? FN (Mandatory nNH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 72WECAV7EWT 2/1/2023 2/112024 X PER OTH- S TUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liab SP 1020955M 10/31/2023 10/31/2024 Per Occurrence 1,000,000 D Professional Liab SP 1020955M 10/31/2023 10/31/2024 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Town of Los Altos Hills is Additional Insured with regard to the General Liability policy when required by written contract per the attached endorsement form IH12001185T. Town of Los Altos Hills Attn: Deborah Padovan, City Clerk 26379 Fremont Road Los Altos Hills, CA 94022 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 ouxzw_ ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72 SBA IB5623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION CITY OF SAN MARCOS AND ITS ELECTED AND APPOINTED BOARDS, OFFICERS, AGENTS AND EMPLOYEES PRIMARY NON-CONTRIBUTORY BASIS CITY CLERK DEPARTMENT 1 CIVIC CENTER DRIVE SAN MARCOS, CA 92069-2918 RE: LOC 001 BLDG 001. CITY OF SANTA ROSA ATTENTION: CITY CLERK 100 SANTA ROSA AVE, ROOM 10 SANTA ROSA, CA 95404 CITY OF SAN GABRIEL 425 SOUTH MISSION DR. SAN GABRIEL, CA 91778 LOC 001 BLDG 001 CITY OF MERCED ATTENTION: INFORMATION TECHNOLOGY 678 18TH ST. MERCED, CA 95340 LOC 001 BLDG 001 CITY OF BEVERLY HILLS 455 N. REDFORD DR. BEVERLY HILLS, CA 92352-0062 TOWN OF LOS ALTOS HILLS 26379 FREMONT ROAD LOS ALTOS HILLS, CA 94022 CITY OF EL CAJON ATTN: KATHIE RUTLEDGE, CITY CL 200 CIVIC CENTER WAY EL CAJON, CA 92020-3916 Form IH 12 00 11 85 T SEQ. NO. 005 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 08/10/22 Expiration Date: 10/31/23