CMAP - Insurance Certificate- T
ACORDO CERTIFICATE OF LIABILITY INSURANCE
DA10/17116 '
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
ices, Inc. InC.
Allianf Insurance Services,
1301 Dove St., Suite 200
CONTACT
AME:
PHONE: PHONE:
Arc. No:
Newport Beach, CA 92660
E -MAIL ADDRESS:
PRODUCER: " "T "'..
949 -756 -0271• Fax 949 - 756 -2713• License No. OC36861
CUSTOMER ID#
INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER:
INSURER(S) AFFORDING COVERAGE
NAIC #
COMMUNITY MEDIA ACCESS PARTNERSHIP (CMAP)
INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO.
23140
850 DAY ROAD
GILROY, CA 95020
INSURER B:
INSURER C:
INSURER D:
$1,000,000
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 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.
NSR
LTR
TYPE .OF.INSURANCE
ADDL
INSR
SUBR
ww
POLICY NUMBER
E
(MMIDD/YY)
(MWDD/YY) .
_ LIMITS
A
GENERAL LIABILITY
X
PAC 1000082 05
09/29/16
09/29/17
EACH OCCURRENCE
$1,000,000
!( COMMERCIAL GENERAL LIABILITY
..._.__
PAGE TO REN1 fffS " " "._PREMISES Ea 000Urrence
$1,000,000
CLAIMS MADE ®', OCCUR
MED EXP (Anyone Person)
N /A-
PERSONAL & ADV INJURY
$1,000,000
GL DED: $1,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
NA'
PRODUCTS- COMP /OPAGG.
$1,000,000
POLICY PRO- F7 LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(Ea Accident
BODILY INJURY (per person)
ANY AUTO
BODILY INJURY (Per aoddent)
ALL OWNED AUTOS
SCHEDULED AUTOS
PROPERTY DAMAGE'
(Per Accidenb
HIRED AUTOS
NON -OWNED AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
EXCESS LIAR
CLAIMS
H
AGGREGATE
DEDUCTIBLE
RETENTION
-
WC STATU- - OTH-
-
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETORYIPARTNER / EXECUTIVE
OFFICER /MEMBER EXCLUDED?
NIA
TORY LIMITS ER
E. L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
(MANDATORY IN NH) IF YES, DESCRIBE
UNDER DESCRIPTION OF OPERATIONS BELOW
E.L. DISEASE- POLICY LIMIT
A
PAC 1000082 05
09/29/16
09/29/17
BROADCASTERS ERRORS &OMISSIONS
$1,000,000 PER OCC; DED: $1,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach Acord 101, Additional Remarks Schedules, B more space is required)
'POLICY.FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE
S RESPECTS AGREEMENT FOR SERVICES WITH THE CITY OF GILROY. CITY OF GILROY, ITS OFFICERS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED. ADDITIONAL INSURED
ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS,
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2^ 009/09) The ACORD me and logo are registered, marks of ACORD 02008 ACORD CORPORATION. All rights res —ed.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF GILROY
7351 ROSANNA ST.
THkEXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
GILROY, CA 95020
AUTHORIZED REPRESqNTATIVE
ACORD 25 (2^ 009/09) The ACORD me and logo are registered, marks of ACORD 02008 ACORD CORPORATION. All rights res —ed.
AGENCY CUSTOMER ID:
LOC #:
AC 11— ADDITIONAL REMARKS SCHEDULE
Page 2 of 3
AGENCY
NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER:
ALLIANT INSURANCE SERVICES, INC.
COMMUNITY MEDIA ACCESS PARTNERSHIP (CMAP)
850 DAY ROAD
POLICY NUMBER
PAC 1000082 05
GILROY, CA 95020
CARRIER
NAICS
EFFECTIVE DATE: 09/29/16
ASSOCIATED INDUSTRIES INSURANCE CO.
23140
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the
Participation Endorsement.
The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the
participation endorsement written notice stating when, not 'less than sixty (60) days thereafter, such cancellation shall, be effective.
Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment
of,premium for the policy or any installment thereof, the coverage may be canceled by the Companyby mailing to the Participating
Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days
thereafter, such cancellation shall be effective.
fhe ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Additional Insured - Designated Person or Organization
This endorsement modifies insurance provided under the following:
SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT
CORPORATIONS
Name of Person or Organization:
Any person or entity that the "Named Insured" has entered into a written agreement, prior to a
loss, to provide defense, indemnity or additional insured protection.
The following is added to Section V. PERSONS OR ENTITIES INSURED:
Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only
as respects "Bodily Injury and "Property Damage arising, in whole or in part, out of the
operations of the Named Insured. The inclusion of such Additional Insured shall not serve to
increase the. "Company's" Limit of Liability as specified in the participation endorsement of this
Policy:
However, additional insured coverage provided by this insurance will not be broader than
coverage required in the written agreement.
Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1
its permission
ACORD® CERTIFICATE OF LIABILITY INSURANCE
DATE 10/17/16 '
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
Alliant Insurance Services, Inc.
1301 Dove St., Suite 200
CONTACT
NAME:
PHONE: PHONE:
A/C. r1o:,._
Newport Beach, CA 92660
E -MAIL ADDRESS:
PRODUCER:
949 - 756 -0271• Fax 949 - 756 -2713• License No. OC36861
-
CUSTOMER ID 0 -
INSURED: SPECIAL' LIABILITY INSURANCE' PROGRAM (SLIP) MEMBER:
INSURER(S) AFFORDING COVERAGE
NAIC #
COMMUNITY MEDIA ACCESS PARTNERSHIP (CMAP)
INSURERA: ASSOCIATED INDUSTRIES INSURANCE CO.
2314
850 DAY ROAD
GILROY, CA 95020
INSURER B:
GENERAL AGGREGATE
INSURER C:
PRODUCTS COMP /OP AGG. _
"
INSURER D: '
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
AUTO DED: '$1,000
INSURER E:
PAC 1000082 05
INSURER F:
09/29/17
COMBINED SINGLE LIMIT
A il"u)__
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 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.
- --
ADDL
INSR
SUER
WVD
POLICY NUMBER
_ _
(MM/DDfYY)__
POLICY
(MWDDNY)_ -
LIMITS .
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE 51 OCCUR
GL DIED: $1000
X
PAC 1000082 05
09/29/16
09/29/1.7
EACH OCCURRENCE
$1,000,Q00
PAGE Occurrence
PREMISES
0,000
0 -
�
MED EXP (A on Person)
N/A
PERSONAL & ADV INJURY
$1,000,000
FGEN'LAGGREGATELIMITAPPLIESPER:
POLICY PRO LOC
GENERAL AGGREGATE
'NA*
PRODUCTS COMP /OP AGG. _
$11,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
AUTO DED: '$1,000
PAC 1000082 05
09/29/16
09/29/17
COMBINED SINGLE LIMIT
A il"u)__
$1,000,000
BODILY INJURY( Per person)
BODILY INJURY (Par accident)
PROPERTY DAMAGE
X
X
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS
EACH OCCURRENCE
AGGREGATE _._...,_
DEDUCTIBLE
RETENTION
WORKERS OMPEN ATI N
AND EMPLOYERS LIABILITY YIN
ANY
OFFICER I MEMBER / EXECUTIVE
OFFICER /MEMBER EXCLUDED?
j (MANDATORY IN NH) IF YES, DESCRIBE
UNDER DESCRIPTION OF OPERATIONS BELOW
NIA
-
we STATU- OTH-
TORY LIMITS ER
®.
E.L. EACH ACCIDENT
- -._.-
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES (Attach Acord 101, Additional Remarks Schedules, H more space is required)
'POLICY FORM DOES NOT CONTAIN A GENERAL'LIABILITY AGGREGATE
S RESPECTS INSURED'S OPERATIONS. THE CITY OF GILROY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS
PRIMARY AND ANY OTHER!INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS INSURANCE. ADDITIONAL INSURED ENDORSEMENT
ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS.
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF GILROY
73511 ROSANNA ST.
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH TH9 POLICY PROVISIONS.
GILROY, CA 95020
AUTHORIZED REPRES NTATIVE
Q
.CAL
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved.
AGENCY CUSTOMER ID:
LOC #:
AI6C� ADDITIONAL REMARKS SCHEDULE
Page 2 of. 3
AGENCY
NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER:
ALLIANT INSURANCE SERVICES, INC.
COMMUNITY MEDIA ACCESS PARTNERSHIP (CMAP)
850 DAY ROAD
POLICY NUMBER
PAC 1000082 05
GILROY, CA 95020
CARRIER
NAIC#
ASSOCIATED INDUSTRIES INSURANCE CO.
23140
EFFECTIVE DATE: 09/29/16
ADDITIONAL. REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the
Participation Endorsement.
The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the
participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective.
Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment
of premium for the policy or any installment thereof, the coverage may be canceled by the Companyby mailing to the Participating
Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days
thereafter, such cancellation shall be effective.
i ne —mu name ana wgo are regiscerea marxs or m—mu
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Additional Insured - Designated Person or Organization
This endorsement modifies insurance provided under the following:
SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT
CORPORATIONS
Name of Person or Organization:
Any person or entity that the "Named Insured" has entered into a written agreement, prior to a
loss, to provide defense, indemnity or additional insured protection.
The following is added.to Section V. PERSONS OR ENTITIES INSURED:
Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only
as respects `Bodily Injury" and "Property Damage" arising, in whole or in part, out of the
operations of the Named Insured. The inclusion of such Additional Insured shall not serve to
increase the "Company's" Limit of Liability as specified in the participation endorsement of this
Policy:.
However, additional insured coverage provided by this insurance will not be broader than
coverage required in the written agreement.
Includes copyrighted material of ISO Properties, Inc., 2004 with Page I of 1
its permission
A T® CERTIFICATE OF LIABILITY INSURANCE
DATE 9/29/1"6 '
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
terns 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
Alliant Insurance Services, Inc.
1301 Dove St., Suite 200
COMA
NAME.
PHONE:
PHONE: A/c. NO:
Newport Beach, CIA 92660
E -MAIL ADDRESS:
949 - 756 -0271. fax 949- 756 -2713• License No. OC36861
PRODUCER:
9/29/2017
CUSTOMER ID 0
" INSURED:
Community Media Access Partnership
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Associated Industries InSurance CoMoanV
23140
PO BOX 1822
INSURER B:
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY aEa Loa
Gilroy, CA 95021
INSURER C:
PRODUCTS- COMP /OPAGG.
$1,000,000
INSURER D:
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
$1,000 DED
INSURER E:
PAC 1000082 OS
INSURER F:
9/29/2017
COMBINED SINGLE LIMIT
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THATTHE 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 MAYBE 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
TR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
(MMIDDIYY)
(MM/DD/YY)
LIMITS
A
GENERALUABILfrY
X COMMERCIAL GENERAL LIABILITY
CLAMS MADE ® occuR
$1,000
PAC 100008205
9/29/2016
9/29/2017
EACH OCCURRENCE
$1,000,000
PREMISES( (Ea RENTED
$1,000,000
MED EXP (Any one person)
N/A
PERSONAL & ADV INJURY
$1,000;000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY aEa Loa
GENERAL AGGREGATE
NA'
PRODUCTS- COMP /OPAGG.
$1,000,000
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
$1,000 DED
PAC 1000082 OS
9/29/2016
9/29/2017
COMBINED SINGLE LIMIT
BODILY INJURY ( Per person)
BODILY INJURY (Per accident)
PROPERTY DAMAGE
X
X
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS
EACH OCCURRENCE
AGGREGATE
DEDUCTIBLE
RETENTION
COMPENSATION KERS
AND EMPLOYERS LIABILITY YIN
ANY PROPRIETORY /PARTNER /EXECUTIVE
OFFICER /MEMBER EXCLUDED'
(MANDATORY IN NH) IF YES, DESCRIBE
UNDER DESCRIPTION O FOPERATIONS BELOW
N/A
-
WC STATU- - - -OTW
TORY LIMITS ER
—
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE -.POLICY'LIMIT
A
NON- PROFIT DIRECTORS AND
OFFICERS
PAC 1000082 05
9/29/2016
9/2912017
$1,000,000 PER OCCURRENCE AND ANNUAL
AGGREGATE, $1,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES (Apach Acord 101, Addhional Remarks Schedules, M more space Is required)
MANUSCRIPT MUNICIPAL COVERAGE FORM. COVERAGE INFORMATION AS PER PROPOSAL. 'Policy Form Does Not Contain A General Liability Aggregate.
NOSE COVERAGE RETRO DATE: 01- May -02
EMPLOYMENT PRACTICES LIABILITY: $1,000,000 PER OCCURRENCE AND ANNUAL AGGREGATE, EXCESS OF A $10,000
SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS.
GtK I II'ICA 11: MULUhN CANCELLATION
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved.
G:V2e wPmNS- ReguerNighr TIhmL9pa lry P &C- PeWw C plstee,42l 16 Sheryl -SLIP EOCe11 &lr SLIP EOC 2 K.-0 x
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
EVIDENCE OF COVERAGE
AUTHORIZED RE'�TA Q
aC.�F
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved.
G:V2e wPmNS- ReguerNighr TIhmL9pa lry P &C- PeWw C plstee,42l 16 Sheryl -SLIP EOCe11 &lr SLIP EOC 2 K.-0 x
AGENCY CUSTOMER ID:
LOC #:
�-� ADDITIONAL REMARKS SCHEDULE Pase 2 of 2
A CORD® _
AGENCY
ALLIANT INSURANCE SERVICES, INC. Community Media Access Partnership
POLICY NUMBER
PAC 1000082 05
NAIC CODE
CARRIER
23140 EFFECTIVE 9/29/2016
Associated Industries Insurance Company
•�Alliant
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
NAMED INSURED: Commumtv Media Access Partnerstu
TYPE OF COVERAGE: Information Security & Priva Insurance
POLICY PERIOD: Se tember 29, 2016 to Se tember =9,2 7
CARRIER:
AIG S ectaltr, Insurance Com an
A xcellent ; Financial Size Category A 1 $2 Billion or Greater as of June 2, 2016
AM BEST RATING:
STANDARD AND POORS:
A+ Strong) pulled as of Se tember 13, 2016
ADMITTED STATUS:
Non Admitted
POLICY NUMBER:
TBD
NOTICE:
Policy coverage sections Information Securi ty & Privacy Liability, Privacy
Penalties of this policy provide
Notification Costs and Regulatory Defense &
basis; except as otherwise provided,
coverage on a claims made and reported
applies only to claims first made
coverage under these insuring agreements
against the insured and reported to underwriters during the policy period.
RETRO ACTIVE DATE:
9/29/2013
CONTINUITY DATE:
9/29/2013
SRP —Security & Privacy, Event Management, Network Interruption, Cyber Extortion
COVERAGE FORM:
Media Content (Internet Only)
COVERAGE AND LIMITS:
PER PERSON PRIVACY EVENT:
3,500,000 Affected Persons Annual Policy and Program Aggregate for all
members combined
100,000 Affected Person Limit and Annual Member Aggregate
(Maximum number of affected persons who may receive
privacy event services. Payments made are not a part of the
Limit of Liability. An approved Chards vendor to provide
20) . �c�� -rT Beach. C A 92060
allizuit In�uranCe Senicei Inc. • 1 1O1 Du Sr • SIIIT� _ l
y}yj 7;(�_27l �����.v.alliantin; nancu.cnm •t_I r11 \ ;0 61
■
v4/liant
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
COVERAGE AND LIMITS $ l0'000'011::::: 0 annual Policy and Program .Aggregate Eor all members combined
(_Aggregate for all coverages combined including claims expenses),
(CONTINUED): subject to sub - limits as noted below.
$ 10,000,000 Media Content Annual Policy and Program Aggregate for all
members combined (Aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 10,000,000 Security & Privacy Liability Annual Policy and Program Aggregate
for all members combined (Aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 10,000,000 Regulatory Action Annual Policy and Program Aggregate for all
members combined (aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 10,000,000 Network Interruption Annual Policy and Program Aggregate for all
members combined (.Aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 10,000,000 Cyber Extortion Annual Policy and Program Aggregate for all
members combined (Aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 5,000,000 Event Management Annual Policy and Program Aggregate for all
members combined (.Aggregate for all coverages combined
including claims expenses), subject to sub - limits as noted below.
$ 250,000 Annual Aggregate Limit of Liability for each member (Aggregate
for all coverages combined including claims expenses), subject to
sub -limits as noted below.
PER MEMBER SUB - LIMITS: $ 250,000 Security &Privacy Sublimit ($250,000 Regulatory action)
$ 250,000 Event Management /Electronic Data Sublimit ($125,000 for event
response)
$ 10,000 PCI -Data Security Standards Assessment Sublimit
The sub -limits of liability are part of, and not in addition to, the overall Annual Aggregate
limit of liability for each member.
Claims expenses shall reduce the applicable limit of liability and are subject to the
applicable retention.
The aggregate limits are the most the carrier will pay regardless of the numbers of
members participating or the number of claims made or the number of events
occurring. There is a possibility that claims by other members could reduce or
eliminate all of the coverage available to each member.
PER MEMBER SELF 100 Records Privacy Event — Affected Person Retention (SIR)
INSURED RETENTIONS $ 10,000 Security & Privacy/ Regulatory Action Self Insured Retention (SIR)
(SIR):
$ 10,000 Media Content Self Insured Retention (SIR)
$ 10,000 Event Management Self Insured Retention (SIR)
$ 10,000/12 Hours Network Interruption Sublimit
"1000 000 C ber Extortion Self Insured Retention SIR
Alliant Insurance Sera ices. Inc. • 1301 Dine St • Suite "- 0() •Newport Beach, CA 92660
(949) 756 -271 - www- alliantin;urance.com • License No. 0056861
•,411ra►rt
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
If a First Parry Event or Third Party Event and any Related Acts triggers coverage unuci
more than one coverage section, the highest applicable retention amount shall apply to all
1. vz arising out of such First P Event or Thud P Event.
ANNUAL PREMIUM Included within SLIP premium
TAXES AND FEES: 100% earned premium at inception
IMPORTANT NOTICE: THE NON ADMITTED & REINSURANCE REFORM
ACT (NRRA) WENT INTO EFFECT ON JULY 21, 2011. ACCORDINGLY,
SURPLUS LINES TAX RATES AND REGULATIONS ARE SUBJECT TO CHANGE
WHICH COULD RESULT IN AN INCREASE OR DECREASE OF THE TOTAL
SURPLUS LINES TAXES AND /OR FEES OWED ON THIS PLACEMENT. IF A
CHANGE IS REQUIRED, WE WILL PROMPTLY NOTIFY YOU. ANY
ADDITIONAL TAXES AND /OR FEES OWED MUST BE PROMPTLY REMITTED
TO ALLIANT INSURANCE SERVICES, INC
INSURING AGREEMENTS' Per Person
Pays on behalf of the insured /member in excess of me re[cnu—
services or products provided by an approved vendor,
Privacy Event
privacy event
insurer or an affiliate insurer with prior written consent within one
the
year of a loss including notification costs, identity theft call center,
services, identity monitoring and victim cost
identity restoration
reimbursement insurance.
Security and
Pays on behalf of the insured /member and claim expenses excess of
to defend a suit or regulatory action alleging a security
Privacy Liability
the retention
failure or a privacy event. Privacy event means any failure to protect
information (whether by "phishin9," other social
confidential
engineering technique or otherwise) including, without limitation, that
heft or other wrongful emulation of
which could result in an identity
he identity of an individual or corporation. Or failure to disclose an
Notice Law or violation of any federal,
event of any Security Breach
state, foreign or local privacy statute alleged in connection with a claim
pre - judgments
for compensatory damaged, judgments, settlements,
and post - judgments.
Pays on behalf of the insured /member in excess of the retention for
Event
loss that is incurred as a result of an alleged security failure or privacy
Management
Loss includes investigation (including forensic investigation) to
event.
determine the cause; public relations firm, crisis management firm or
electronic data; and to
law firm; to restore, recreate or recollect
determine whether electronic data can or cannot be restored, recreated
or recollected.
Network
Pays on behalf of the insured /member in excess of the remaining
sumeoffor costs
after the
Interruption
incurred 120 daysa after interruption, which is he the
following calculated on an hourly basis.
1) Net income (net profit or loss before income taxes) that
would have been earned and
2) Continuing normal operating expenses incurred, including
payroll.
Alliant Insurance Services. Inc. • 1301 Dove St • Suite 200 • Newport Beach. CA 92660
(9:19) 756 -2713• www.alliantinsurance.com • License No. OC36H61
•,nIliarrt
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
7Media on behalf of the insured /member in excess of the retention for
ngful acts in connection with media content in any form (including
ertising and written, printed, video, electronic, digital or digitized
tent) of broadcasts or publications. Wrongful acts include
ngement of copyright and trademark, plagiarism or piracy, invasion
rivacy, defamation, libel and slander.
s on behalf of the insured /member in excess of the retention
nies paid with the insurer's prior written consent monies paid to
inate or end a security threat that would otherwise result in harm
n insured and costs to conduct an investigation to determine the
cause of the security threat. Security threat is any threat or connected
series of threats to commit an intentional attack against a computer
system for the purpose of demanding money, securities or other
tangible or intangible property of value from an insured.
FORMS & ENDORSEMENTS: • Specialty Risk Protector — Cyber Extortion Insurance
• Specialty Risk Protector — Event Management Insurance
• Specialty Risk Protector — General Terms & Conditions
• Specialty Risk Protector — Media Content Insurance
• Specialty Risk Protector — Network Interruption Insurance
• Specialty Risk Protector — Security & Privacy Liability Insurance
• Notice of Claim (Reporting by Email) — Endorsement
• Economic Sanctions — Endorsement
• Control Group Definition Amendatory Endorsement (Non - Administrative Personnel
• Conduct Exclusion Amendatory Endorsement
• Cyberterrorism Coverage Endorsement
• Criminal Reward Coverage Extension Endorsement
• E- Discovery Consultant Services Coverage Endorsement
• Retention Amendatory Endorsement
• Subsidiary Threshold Amendatory Endorsement —15% of gross sales
• Choice of Panel Counsel Endorsement
• Aggregate Event Management Sublimits Endorsement
• Cyberedge Cyber Media Coverage Endorsement
• California Punitive Damages Law Endorsement
• Insured Definition Amendatory Endorsement (Volunteers)
• Tie In of Limits Endorsement (Absolute)
• Other Insurance Provision Amendatory Endorsement
• Coverage Summary Endorsement
• Covered Entity Endorsement
• PCI -DSS Assessment Coverage Endorsement Sublimit for Each Covered Entity)
NOTICE OF CLAIM: • IMMEDIATE NOTICE must be made to AiG C'iaizon Inc. o
f all potential
claims and circumstances (assistance, and cooperation clause applies)
• Claim notification under this policy is to:
AIG Claims, Inc.
Attn: c -Claim
175 Water Street
New York, NY 10038
c clai nAchartisinsurance.com
Fax (866) 227 -1750
Alliant Insurance Services. Inc. • 1301 Dove St • Suite 200 • Newport Beach. CA 92660
(949) 756 -2713• w ww.alliantinsurance.com • License No. 006861
0
n411iant
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
DATE PREPARED: Se tember 29, 2016
BROKER ALLIANT INSURANCE SERVICES, INC • NEWPORT BEACH, CA
Gordon B. DesCombes, Executive Vice President
Christine Tobin, Senior Vice President
Sheryl Fitzgerald, Account Manager — Team Lead
Anne Krueger, Account Representative
Autumn Stallings Account Representative
This summary of insurance is provided as a matter of convenience and information only. All information included in this
values,
summary, including but not limited to personal and real property es, locations, operations, products, data, automobile
schedules, financial data and loss experience, is based on facts and representations supplied to Alliant Ser Insurance Services, Inc. by
you. This summary does not reflect any independent study or investigation by Alliant Insurance Services, Inc. or its agents and
employees. may have. -All
This summary does not add to, extend, amend, change, or alter any coverage in any actual policy of insurance you
coverage,
existing policy terms, conditions, exclusions, and limitations apply. For specific information regarding y
please refer to the policy itself. Alliant Insurance Services, Inc. will not be liable for any claims arising from or related to
information included in or omitted from this proposal of insurance
Alliant embraces a policy of transparency with respect to its compensation from insurance transactions. Details on our
compensation policy, including the types of income that Alliant may earn on a placement, are available on our website at
a1L+ant coin. For a copy of our polity or for any inquiries regarding compensation issues pertaining to your account
nc., Attention: General Counsel, 701 B Street, 6th Floor, San Diego,
you may also contact us at: Alliant Insurance Services, I
CA 92101.
Analyzing insurers' over -all performance and financial strength is a task that requires specialized skills and in -depth technical
understanding of all aspects of insurance company finances and operations. Insurance brokerages such as Alliant Insurance
typically rely upon rating agencies for this type of market analysis. Both A.M. Best and Standard and Poor s have been
industry leaders in this area for many decades, utilizing a combination of quantitative and qualitative analysis of the
information available in formulating their ratings.
A.M. Best has an extensive database of nearly 6,000 Life /Health, Property Casualty and International companies. You can
visit them at wn =nv ambestcom. For additional information regarding insurer financial strength ratings visit Standard and
Poor s website at °- ^'andardandpoors.com.
Our goal is to procure insurance for you with underwriters possessing the financial strength to perform. Alliant does not,
however, guarantee the solvency of any underwriters with which insurance or reinsurance is placed and maintains no
responsibility for any loss or damage arising from the financial failure or insolvency of any insurer. We encourage you to
review the publicly available information collected to enable you to make an informed decision to accept or reject a particular
underwriter. To learn more about companies doing business in your state, visit the Department of Insurance website for
that state.
NY Regulation 194
Alliant Insurance Services, Inc. is an insurance producer licensed by the State of New York. Insurance producers are
authorized by their license to confer with insurance purchasers about the benefits, terms and conditions of insurance
contracts; to offer advice concerning the substantive benefits of particular insurance contracts; to sell insurance; and to
obtain insurance for purchasers. The role of the producer in any particular transaction typically involves one or more of
these activities.
Alliant Insurance Services, Inc. • 1301 Dove St • Suite 200 • Newport Beach. CA 92660
J949) 756.2713. www.alliantinsurance.com • License No. 0C36861
g411 "rant
SPECIAL LIABILITY INSURANCE PROGRAM (SLIP)
CYBER LIABILITY COVERAGE SUMMARY
Compensation will be paid to the producer, based on the insurance contract the producer sells. Depending on the insurers)
and insurance contract(s) the purchaser selects, compensation will be paid by the insurer(s) selling the insurance contract or
by another third party. purchaser compensation elects. In some cases, depending f tors unumber s the volume of businness a producer provides to
and the insurer(s) the
cts a producer provides to an insurer also may affect compensation.
an insurer or the profitability of insurance contra
The insurance purchaser may obtain information about compensation expected to be received by the producer based in
whole or in part on the sale of insurance to the purchaser, and (if applicable) compensation expected to be received based
in whole or in part on any alternative quotes presented to the purchaser by the producer, by requesting such information
from the producer.
Changes and Developments
It is important that we be advised of any changes in your operations, which may have a hearing on the validity and or
adequacy of your insurance. The types of changes that concern us include, but are not limited to, those listed below:
• Changes in any operations such as expansion to another states, new products, or new appli cations of existing
products.
• Travel to any state not previously disclosed.
• Mergers and /or acquisition of new companies and any change in business ownership, including percentages.
• Any newly assumed contractual liability, granting of indemnities or hold harmless agreements.
• Any changes in existing premises including vacancy, whether temporary or permanent, alterations, demolition, etc.
Also, any new premises either purchased, constructed or occupied
• Circumstances which may require an increased liability insurance limit.
• Any changes in fire or theft protection such as the installation of or disconnection of sprinkler systems, burglar
alarms, etc. This includes any alterations to the system.
• Immediate notification of any changes to a scheduled of equipment, property, vehicles, electronic data processing,
etc.
■ property of yours that is in transit, unless previously discussed and /or currently insured.
Certificates / Evidence of Insurance
• A certificate is issued as a matter of information only and confers no rights upon the certificate holder. e
certificate does not affirmatively or negatively amend, extend or alter the coverage afforded by a polity. Nor does
it constitute a contract between the issuing insurer(s), authorized representative, producer or certificate holder.
• You may have signed contracts, leases or other agreements requiring you to provide this evidence. In those
agreements, you may assume obligations and /or liability for others (Indemnification, Hold Harmless) and some of
the obligations that are not covered by insurance. We recommend that you and your legal counsel review these
documents.
of insurance, you may be required to name your client or customer on your
In addition to providing a certificate
policy as an additional insured. This is only possible with permission of the insurance company, added by
endorsement and, in some cases, an additional premium.
By naming the certificate holder as additional insured, there are consequences to your risks and insurance polity
including:
• Your policy limits are now shared with other entities; their claims involvement may reduce or exhaust your
aggregate limit.
• Your policy may provide higher limits than required by contract; your full limits can be exposed to the addition
insured.
• There may be conflicts in defense when your insurer has to defend both you and the additional insured.
Alliant Insurance Services, lnc. • 1301 Dove St • Suite 200 • Newport Beach. CA 92660
(939) 7-;6 -2713• Aww.alliantin ;urance.corn • Licen+e No. OC36861