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HomeMy WebLinkAboutFidelity National Information Serv. Inc.—� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/04/2024 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 cerci icate holder is an ADDITIONAL INS RED, the pohcy(#es) must have ADDITIONAL I SURER prov slops 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 Aon Risk services south, Inc. Charlotte NC office NAMEACT HIS (21,N..Ext): (866) 283-7122 FAx (800) 363-0105 EgMAIL pODRESS: 1111 Metropolitan Avenue, suite 400 Charlotte NC 28204 USA INSURER($) AFFORDING COVERAGE. NAIC #k INSURED INSURER A: AXIS Insurance company 37273 Fidelity National information serv. Inc. and all subsidiaries 601 Riverside Ave INSURER B: Transportation Insurance Co. 20494 INSURER C: continental Casualty company 20443 Jacksonville FL 32204-2946 USA INSURER D: American casualty Co. of Reading PA 20427 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE INSURER F: The Continental insurance Company 35289 INSURER F: X POLICY ❑JECOT LOC _ PRODUCTS - COMP/OP AGO rn%1r-0Afl- CQ t1C0Tterr1AT0 ntllaeQco. K701 A070)ra r.illeeac®. THIS IS f5-UERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TU THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERMOR 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. Limits shown are as requested Xp LTR TYPE OF INSURANCE INS WVD POLICY NUMBER M IDD/YYYY MM/DD/Y YY LIMITS X COMMERCIAL GENERAL LIABILITY GL EACH OCCURRENCE $2,000,000 CLAIMS -MADE [X]OCCUR DAMAGE'1'0 HEN MID PREMISES E occurrence)$2,000,000 MED EXP (Any one person) EXCluded PERSONAL&ADV INJURY $2,000,000 L100 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 n X POLICY ❑JECOT LOC _ PRODUCTS - COMP/OP AGO $4,000,000 OTHER: o h CY AUTOMOBILE LIABILITY BUA70.36257962 01/01/2023 04/01/2024 COMBINED SINGLE LIMIT E accident, $2,000,000 'n BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accldent) OWNED SCHEDULED 4) AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED tt6p PROPERTY DAMAGE ONLY AUTOS ONLY Per accident)t 1: E X UMBRELLALIAB X OCCUR 7 181463 9 01 /617M23 04 1 2024 EACHOCCURRENCE $10,000,000 EXCESS LIAS CLAIMS -MADE AGGREGATE $10,040,000 DED I X IRETENTION $10,000 D WORKERS COMPENSATION AND WC7036257976 01/0-1-/-202 3 _047772-M2_4 X I PER STATUTE pTH ER EMPLOYERS' LIABILITY YIN WC AOS E.L. EACH ACCIDENT $1,000,000 B - ANY PROPRIETOR / PARTNERI EXECUTIVE NIA WC7036292615 01/01/2023 04/01/2024 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) wC w2 E.L. DISEASE -EA EMPLOYEE $1,000,000 IIee describe undor 0 5GRIPTION OF OPERATIONS below - -� E.L. DISEASE -POLICY LIMIT 1'000,000 000,000 A Cyber Liability FOOIOO 474790605 11/09/2022 04/01/2024 E&O/Cyber 15,0 a0,000 E&p/cyber/Prof Liab ME SIR applies per policy terns & conditions ,r DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apses is required) certificate Holder is included as an additional insured for General Liability and Automobile Liability coverage if required by contract, but only with respect to activities or obligations performed under the contract and only to the limits required by the contract per the terms and conditions of the policies,_ I CERTIFICATE HOLDER City of Las Altos Hills 26379 Fremont Rd. LOS Altos Hills CA 94022 USA ACORD 26 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 'HORIZED REPRESENTATIVE 01988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000095492 LOC #: ! ADDITIONAL REMARKS -SCHEDULE Page _ of AGENCY NAMED INSURED Aon Risk Services South, Inc. Fidelity National Information Serv. Inc. POLICY NUMBER See Certificate Number: 570103497256 CARRIER NAIC CODE See Certificate Number: 570103497256 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACQRD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE MAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES if a policy below does not include limit information, refer to the corresponding policy on the ACORTa certificate form for policy limits. 1NSR LTR TYPE Or INSURANCE ADDL INSD SUBR WYD POLICY NUMBER POLICY EPIrLCTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS B D WORKERS COMPENSATION N/A N/A WCE7036298219 wC Ohio WC7036292601 WC CA, MA 01/01/2023 01/01/2023 04/01/2024 04/01/2024 ACQRD 101 (2008/01) © 2008 ACQRD CORPORATION. All rights reserved. The ACQRD name and logo are registered marks of ACQRD