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HomeMy WebLinkAboutCHAC dba Community Health Awareness Council0 ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F L.... -' 11 /22/2023 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 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 Business Professional Insurance Associates NAME; CT Tirzah Tyler (A/CNNo Ext: (650)341-4484 (AJC No): (650)341-4465 1519 South B Street ao RIESS: TTyler@bpia.net San Mateo, CA 94402 INSURERS AFFORDING COVERAGE NAIC # License #: OD69286 INSURER A: Nonprofits Insurance Alliance of CA 10023 PERSONAL & ADV INJURY $ 11000,000 INSURED CHAC INSURER B: Emp overs Preferred Ins. Co. 10346 INSURERC: DBA Community Health Awareness Council A P.O. BOX 335 INSURER D: Mountain View, CA 94042 INSURERE: 12101/2024 EO aocld.ntSINGLE LIMIT $ 1,000,000 INSURER F: COVERAGES CERTIFICATE NUMBER: 00003230-1523832 REVISION NUMBER: 16 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 INSID SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR X Empl Benefits Liab Y 2023-04654 12/01/2023 12/0112024 EACH OCCURRENCE $ 11000,000 PREMISES (E. occurrence) $ 500,000 MED EXP (Any one person) $ 20,000 PERSONAL & ADV INJURY $ 11000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JE� D LOC OTHER: GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMPIOP AGG $ 3,000,000 Improp Sexual Cond $ 1,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY 2023-04654 12/0112023 12101/2024 EO aocld.ntSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Pr cidentDAMAGE $ eeac A X UMBRELLALIAB. EXCESS LIAB X OCCUR CLAIMS -MADE 2023-04654-UMB 12/0112023 12101/2024 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED I X I RETENTION s None $ B YERS' LI COMPENSATION AND EMPLOYERS' AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A EIG2738605 12/0112023 12/01/2024 X. STATUTE OC-RH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,0002000 A Soc. Serv. Prof Liab 2023-04654 12/01/2023 12/01/2024 Occur/Aggr. 1 mil/2 mil DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Addltlonal Remarks Schedule, maybe attached If morn space Is required) Certificate Holder is named as Additional Insured with respects to the insured's business operations. Additional Insured applies to General Liability policy only. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by THT on 11/22/2023 at 04:08PM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 26379 Fremont Road Los Altos, CA 94022 AUTHORIZED REPRESENTATIVE I I I 2!� THT ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by THT on 11/22/2023 at 04:08PM