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HomeMy WebLinkAboutSourcewise (2)SOURCEW-01 CERTIFICATE OF LIABILITY INSURANCE SRSPATRA3 DATE (MM/DD/1 12122/20; L HOLDER.' +kl�t moi: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI_. 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 -- C%TACT House - SRS Suhr Risk NA E: ProCo Insurance Services 910 E Hamilton Ave #410 _ PHONE FAX (A/C, No, Ext): �C, No): E-MAIL None none.com ADDRESS: Campbell, CA 95008 INSURER(S) AFFORDING COVERAGE NAIC # _ INSURER A: Alliance of Nonprofits for Insurance, Risk Retention Group _ 10023 INSURED INSURER B: 1/1/2024 INSURER C: EACH OCCURRENCE $ 1'000'000 Sourcewise INSURER D: See "Other Covg"' 3100 De La Cruz. Blvd, #310 Santa Clara, CA 95054 — INSURER E --- -- INSURER F: ! COVERAGES CER'TIFICA E NUMBER: 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 INSD_ SUBR WVD POLICY NUMBER POLICY EFF LW1DDLNYYY POLICY EXP MM/DDIYYYYI _ LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 V71 ^ I OCCUR X Owner's & Contractor 2024-14829 1/1/2024 1/1/2025 EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTED 500,000 PREMISES � ocrurLe ce $ __ 20,000 MEI7EXP"An oneperson) $ See "Other Covg"' _ ___ PERSONAL. & ADV INJURY $ 1,0®0,000 GENT. C - AGGREGATE LIMIT APPLIES PER: POLICY L� jLCT i ^ LOC -- 3,000,000 GENERAL A<3GREGATE $ ! , _ PRODUCTS • COMN/nP AGG $__ 3,000,000 --- - ---- COMBINED SINGLE LIMIT 1,000,060 -(Sacci a itj- ----- $ --- --- — - A AUTOMOBILE OTHER: R:_� LIABILITY i - BODILY INJURYSPerpason $ . ..... - - X -_ ANY AUTO OWNED SCHEDULED AIUTOS ONLY AUTOS 2024-14829 1/1/20?.4 1/1/2025 BODILY INJURYSPer accident $ (Parra o denfDAMAGE $ AUTOS ONLY AIOJ'i S ONLY -- - -- --- ----- --- $ --- -- EACH E)CCURRENCE $ 2,000,000 A X - -UMBRELLA X OCCUR -----�- - - -- - --- — EXCESSL.IAB _ CLAIMS -MADE 202314829UMBNPO 1/1/2023 1/1/2024 AGGREGATE $ �Agg & SSSPL 21000,000 -- DED IX RETENTION-$_ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE Or-FICER/MMBErrd EXCLUDED? (Mandatory n NIi) If yes; describe under NIA _— PER OTH- — STATUTE E E.L.. EACH ACCIDENT $ --- E.L. DISEASE - EA EMPLOYEE $ _ DESCRIPTION OFOPERATIONSbelow E.L_DISEASE - POLICY LIMIT $ A ____ General Liability --202314829 V _ _ _ 1/1/2023 1/1/2024 Aggregate Limit 3,000,000 A General Liability 202314829 1/1/2023 1/1/2024 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 107, Additional Remarks Schedule, may be attached if more space is required) Proof of coverage. Town of Los Altos Hills 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 w�� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A�`C7Rll� SOURCEW-01 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORI--- 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 NRMPCT House - SRS Suhr Risk ProCo Insurance Services PHONE Ext): (AIC, No): 910 E Hamilton Ave E-MAIL #410 ADDRESS: None@none.COm Campbell, CA 95008 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Alliance of Nonprofits for Insurance, Risk Retention Group 10023 INSURED INSURER B: SOurcewlse INSURER C : 3100 De La Cruz Blvd, #310 INSURER D: Santa Clara, CA 95054 INSURER E INSURER F: SRSPATRA3 DATE (MM/DDI` CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1117/201 I '� HOLDER.' INSD INSD D BY THE POLI POLICY NUMBER C()VFPAnFA r FRTIFICOTF All IMRFR• DMIMInki KII IIIARCD. 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. INS, LTR TYPE OF INSURANCE INSD INSD SUER WVD POLICY NUMBER POLICY EFF MM DD YYYY POLICY EXP MM/Db LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 2024-14829 1/1/2024 111/2025 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ X Owner's & Contractor MED EXP An one person)$ 20,000 X See "Other Covg" PERSONAL & ADV INJURY $ 1'000,000 GEHL AGGREGATE LIMIT APPLIES PER: POLICY FI %er X LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OPAGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY a aBc d DtSINGLE LIMIT $ 1,000,000 RM BODILY INJURY Per person)$ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 2024-14829 1/1/2024 1/1/2025 BODILY INJURY Per accident $ Pe�acCldent AMAGE $ p AURTEOS ONLY MRORF A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2'000'000 AGGREGATE $ EXCESS LIAB CLAIMS -MADE 2024-14829-UMB 1/1/2024 1/1/2025 DED X RETENTION $ 10,000 Agg & SSSPL 2,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OpFICER/MEMBE EXCLUDED? (Mandatory hi NH) If yes, describe under N 1 A PER OTH- TATU E ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Social Services Prof 2024-14829 1/112024 1/1/2025 Aggregate Limit 3,000,000 A Social Services Prof 2024-14829 1/1/2024 1/1/2025 Occurrence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Proof of coverage. Town of Los Altos Hills 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 ��� ACORD 25 (2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD