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Active Sports Clubs - Insurance Certificate
Client#: 26916 ACTIACQU ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/2312014 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(ies) must 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 Barney & Barney mNE, T Rose King PHONE 858 587 7521 858 909 9840 A/C No Ext : A/C No P.O. Box 85638 E-MAIL rosel4,��,.�barne rosek@bameyandbamey.com "tom Y y• com CA License #01-118131 San Diego, CA 92122 INSURERS) AFFORDING COVERAGE NAIC # INSURERA.: Philadelphia Indemnity Insuranc 18058 INSURED Active Acquisition Partners LLC; Active Sports Clubs PO Box 23558 INSURER B: Everest National Insurance Co 10120 INSURER C: INSURER D San Francisco, CA 94126 INSURER E INSURER F: COVERAGES CERTIFICATE 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 CONTRACTOR 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 INSR SUB WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DCAY LIMITS A GENERAL LIABILITY X PHPK1143095 3/03/2014 03103/201 EACH OCCURRENCE $11000000 X COMMERCIAL GENERAL LIABILITY EM ISE PR S EaEoocTu ence 000,000 CLAIMS -MADE FX1 OCCUR MED EXP (Anyone person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 POLICY EC X LOC $ A AUTOMOBILE LIABILITY PHPK1143095 3/0312014 03103/201 CMBI ED Ee accideMSINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Pecaccident - $ NON -OWNED HIRED AUTOS AUTOS $ A X UMBRELLA LIAB X OCCUR PHUB451967 3103/2014 03/03/2015 EACH OCCURRENCE $10.000,000 AGGREGATE $10,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? N NIA CA10002071142 2/31/201412/31/201 X WS- OTH- E.L. EACH ACCIDENT $1.000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional Liab PHPK1143095 0310312014 1 031031201 $1,000,000 Ea Claim Claims Made $1,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) RE: Gilroy Fire Testing City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement City of Gilroy, Officers, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ty y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE (5?60— ),1 • Ari—o ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S243504/M243491 KIN R INSURED: Active Acquisition PartnersLLC; POLICY #: PHPK1143095 POLICY PERIOD: 03/03/2014 TO 03/03/2015 CO>NYERCIA� CIEWERAL UABILJTY ©G 2026 0704 THIS MORSEMENt CAGES THE POL Y. PLEASE REIN rr CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION T* axwr> wmt modes tnsumnoe PMAded u the folbiywlnw: OOOt MERCK GENERAL. L.IABILITY.CONERAGE PART City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 RE: Gilroy Fire TestingCity of Gilroy, its officers, officials and employees are named as an additional insured, per the attachedendorsement Section 0 - Who b An Insuued is emended t5. h. 6LIdeas en Iinsured dV "Mn(0yorW-F -IT'L r�timt{s) thdMi i �p §OedWe, but .doily *0 reseed J-D bbft for tuft IrW. *pFoMty Via. or "per osl .mad edvefthtb: in jury' diusod. in Or' in PW: by your a6 0 wnisai M- or *6 eoEo ar ontika- dm of fie seft an your beh*. A In ft pedorarmoe of your onSaing opemilang.or g: In carioeddh With your Priemims owned by or ri qW to yogis. C.S 20 .07 04 0 180 PMP9rdW I=. 2304 Page 1 of f