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Cathedral of Faith - Insurance CertificateFRIFRIR -11 CRI IRNA CERTIFICATE OF LIABILITY INSURANCE E (MM1ND DATE 09108/2017 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 C_ O_ NTRACT BETWEEN E_E_ N THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holderis 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 ?o* Carol Bums PAlCNNO Ert: 559 447 600 331 FAX No :(559) 447 -4586 Der Manouel Insurance 8 Financial Services, Inc. 548 W Cromwell Ave Ste 101 Fresno, CA 93711' iffik., Cbums dmig.COm - _ INSURER(S) AFFORDING COVERAGE NAIC # 09/01/2018 _ INSURER A: Great American Insurance Co. 16691 INSURED Friendly Bible Church INsuRER B: Comerstone Comp, Inc. MED EXP (Any one - $ 15'000 dba Cathedral of Faith INSURER C: PERSONAL 8 ADV INJURY _ INSURER D: GEN'L AGGREGATE LIMIT APPLES PER X POLICY 11:1 jea LOC OTHER - Reaching Out, Inc. 2315 Canoas Garden Road San Jose, CA 95125 INSURER E : PRODUCTS - COMP /OP AGG $ - 3'000'000 $ INSURER F AUTONIOBRE LIABILITY - X ANY AUTO _ OWNED SCHEDULED _ AIUR�TE�O�pS ONLY AUUTNO.pSWryEp 'AUTOS ONLY AUTOS ONLY C11VFRA[:FR CFRTIFICATF NIIMRFR- 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 BYIPAID CLAIMS INSR - - -- — -� TYPE OF INSURANCE ADDL INSD UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X PAC0535515 09/01!2017 - - 09/01/2018 _ EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTED P EMI E Ea occurrence 1,000,000 $ MED EXP (Any one - $ 15'000 PERSONAL 8 ADV INJURY _ $ - 1'000'000 GEN'L AGGREGATE LIMIT APPLES PER X POLICY 11:1 jea LOC OTHER - GENERAL AGGREGATE__— 3'000'000 PRODUCTS - COMP /OP AGG $ - 3'000'000 $ A AUTONIOBRE LIABILITY - X ANY AUTO _ OWNED SCHEDULED _ AIUR�TE�O�pS ONLY AUUTNO.pSWryEp 'AUTOS ONLY AUTOS ONLY - CAP0535516 09/0112017 09101/2.018 COMBINED SINGLE LIMIT $ 1,000,000 BODILYINJURY Per on '$ - BODILY INJURY Per acadent $ P0 �deTMfrt AMAGE li$ A X UMBRELLA LIAB EXCESS LIAB X �'� OCCUR CLAIMS -MADE _ UMB0535517 -- - 09/0112017, 09101 /2018' EACH OCCURRENCE - - ----15,000,000 $ AGGREGATE - - _ $ DED I X I RETENTION$ 10,000 _ '$ 15'000,000 B WORKERS COMPENSATION - -- — AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE �FICER/rM R EXCLUDED? - a iAandatory in NH) 'yes, descnbe under- -- DESCRIPTION OF OPERATIONS below NIA III - 0140060704 01/01/2017 ' 01/01/2018 PER X 0TH= i'E L EACH ACCIDENT $ 2'000'000 E L DISEASE - EA EMPLOYE $ 2,000,000 E L DISEASE - POLICY LIMIT $ 2,000,000 I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached_ If more_ s_ pace Is regmlred) Re: Use of San Ysidro Recreation Facility, Date: Policy Term Location: 7700 Murray Ave, Gilroy, CA Endorsement attached: CG 20 11 01 96 City of Gilroy _ 7351 Rosanna Street Gilroy, CA 95020 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' INSURED Friendly Bible Church, dba. Cathedral of Faith COMMERCIAL GENERAL LIABILITY POLICY NUMBER PAC0535515 CG 20 110196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You) San Ysidro Recreation Facility, 7700 Murray Ave, Gilroy, CA 2. Name of Person or Organization (Additional Insured). State or Government Agency or Subdivision or Political Subdivision, City of Gilroy, it's officials, employees and volunteers are included as Additional Insured 3. Additional Premium 0 (If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement ) WHO IS AN INSURED (Section II) is amended to include as an insured the persorn or organization shown in the Schedule but only with respect to liability ansmg out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional'exclusions This insurance does not apply to I Any "occurrence" which takes place after you cease to be a tenant in that premises 2. Structural alterations, new construction or demo_ lition operations performed b_ y or on behalf of the person or organization shown in the Schedule CG 20 1101 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 FRIFRIR111 RVANCF ACORO' CERTIFICATE OF' LIABILITY INSURANCE DATE (MM/DD /YYYY) 09/0112017 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 BETWEENI THE ISSUING INSURER(S), AUTHORIZED AEPRESENTATIVE 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 endomemen s . PRODUCER li CO T CT Carol Burns (AICNE e:d):_(559 447 -4600 331 _ FAX _ ) _ _ lac, Nol:(559) 447 -4586 Der Manouel Insurance 8 Financial Services, Inc. 548'W CrOmW ®II Ave Std_101 Fresno, CA 93711 E-MAIL -- . cburns dmig.coin INSURER(S) AFFORDING COVERAGE I NAIC 0 . _ INSURER -Great American Insurance Co. 16691 INSURED Friendly Bible Church dba Cathedral of Faith Reaching INSURER B: Comerstone Comp, Inc. MED EXP (Any one person) $ 15'000 Out, Inc. INSURER C : PERSONAL & ADV INJURY INSURER D: GENT AGGREGATE LIMIT APPLIES PER X POLICY PRA LOP _ � JECT � LOP OTHER dba Cathedral of Faith 2315 Canoas Garden Road San Jose, CA 95125 INSURER E: PRODUCTS = COMP /OP AGG $ 3'000 000 ' $ INSURER F: AUTOMOBILE CAVFRAt±FC CERTIFICATE MIIMRFR• RFVIRInN,NIIMRFR- 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, EXCL'USIONSAND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF- POLICY EXP OMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR III .__ _ .. . _ EACH OCCURRENCE $ 1,000,000 DAMAGE PREMISES occurrence) $ 1,000,000 MED EXP (Any one person) $ 15'000 PERSONAL & ADV INJURY $ 1'000'000 GENT AGGREGATE LIMIT APPLIES PER X POLICY PRA LOP _ � JECT � LOP OTHER GENERAL AGGREGATE $ 3'000'000 PRODUCTS = COMP /OP AGG $ 3'000 000 ' $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS_-- Dp AUTOS ONLY AUTO O �Y CAP0535516 09101/2.017 0.9 10112018_ ICI COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY Per n $ BODILY 40PmtleTMntU AMAGEacaderd p� $ A X UMBRELLA LIAB EXCESS LI►B X OCCUR CLAIMS -MADE UMB0535517 09/01/2017 09/01/2018 EACH OCCURRENCE $ 15'000'000 AGGREGATE $ DIED ', X RETENTION $ 10,000 15,000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE FFICERIMEMBER EXCLUDED? �N �Aandatory n ) - - - - - If yes, desenbe under DESCRIPTION OF OPERATIONS below N / A 0140060704 - 01/01/2017 _ 01/01/2018 PER_ __ X OTH- ER EL EACH'ACCIDENT 2 000 000 $ - - - ' - - E L DISEASE = EA EMPLOYE E'$ 2,000,000 E L DISEASE - POLICY LIMIT -I 2,000,000 $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached I more space Is required) Re: Use of San Ysid_ro Recrea_ Lion Facility, Date: Policy Term Location: 7700 Murray Ave, Gilroy, CA Endorsement attached: CG 20 11 01 96 City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE ESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE, _ TI THEREOF, NOTICE WILL- BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE U x 14' ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURED Friendly Bible Church, dba Cathedral of Faith POLICY NUMBER PAC0535515 COMMERCIAL GENERAL LIABILITY CG 20 110196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance'provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 4. Designation of Premises (Part Leased to You) San Ysidro Recreation Facility, 7700 Murray Ave, Gilroy, CA 2. Name of Person or Organization (Additional Insured)- State or Government Agency or Subdivision or Political Subdivision, City of Gilroy, it's officials, employees and volunteers are included as Additional Insured 3. Additional Premium- 0 (If no entry appears above, the information required to complete this endorsementwdl be shown in the Declarations as applicable to this endorsement_.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part Of the premises leased to you and shown in the Schedule and subject to the following exclusions - This insurance does not apply to 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule CG 20 11 01 96 Copyright, Insurance services Office, Inc., 1994 Page 1 of 1 ❑ FRIEN -1 OP ID: CA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/VVW) 0826/2016 1 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 REACT Carol Burns Der Manouel Ins 8 Fin Svcs Inc PHONE 559.447 -4600 FAX. No: 559 - 4474586 Der Manouel Insurance Group Arc E-MAIL I: P.O. Box 28906 SS. cbums@dmig.com — Fresno, CA 93729 -8906 Carol Burns _ INSURENS) AFFORDING COVERAGE __ NAIC tl INSURER A; Great American_ Insurance Co. 116691 INSURED Friendly Bible Church _ INSURER B: CornerstoneComp, Inc. dba Cathedral of Faith INSURER C: Reaching Out, Inc. 2315 Canoas Garden Road INSURER D: San Jose, CA 95125 INSURER E; INSURER F: ,aao�o. DFVICIAN NI IRARFR• v 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' TYPE OF INSURANCE POLICY EFF POLICY EXP LTR I POLICY NUMBER POLICY MAUD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ CAMS MADE � PAC0535515 001/2016 09/01/2017 PREMISES Ea Rer R A - 3 _ 1,000,00 MED EXP one persor) S 10,60 PERSONAL SADV INJURY S 1,000,00 GEN'L AGGREGATE LIMSi APPLIES PER GENERAL AGGREGATE $ 3,000,00 X POLICY J£CT [ ] LOC PRODUCTS - COMP /OP AGG S 3,000,00 s _ OTHER: AUTOMOBILE UABRJTY !COMBINED SINGLE LIMIT Ea accident` S 1,000,00 BODILY INJURY (Per person) i A X ANY AUTO AP0636516 09101/2016 09/01/2017 ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED WRED AUTOS AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Par accident S _ a A X :UMBRELLA 1A8 X IOCCUR EXCESS LAB 71 M1 aDE UMB0535517 09/01/2016 I EACH OCCURRENCE 09101/2017 AGGREGATE S 15,000,00 s 15,000,00 DEC X RETENTIONS 10000 $ i WORKERS COMPENSATION AND EMPLOYERS' LIABILITY B AN PROPRIETOR/PARTNER /EXECUTIVE YIN OFPCERIMEMBER EXCLUDED? 7N (Mandatory In NH) MIA X0140060704 01/01/2016 01/01/2017 P H- STATUTE X ER E.L. . 2,000,0 EL DISEASE - EA EMPLOYEE $ 2,000, If yes, describe under DESCRIPTION OF OPERAT IONS below EL DISEASE - POLICY LIMIT - -` — $ 2,000,00 i DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addltlonal Rematks SchedWe, may Se attached If rn e spaca is eyalred) City of Gilroy, it's officials, employees and volunteers are included as Additional Insured as respects to General Liability as required by written contracr or agreement Re: Use of San Ysidro Recreation Facility, 7700 Murray Ave, Gilroy, CA Endorsement attached: CG 20 11 01 96 I I r-r% I Irf-.,A I r MUUUMM L ANUtLLA I IUN GILRO-4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE © 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PAC0535515 dba: Cathedral of Faith L 2 COMMERCIAL GENERA ABILITY LEASE READ IT CAREFULLY. THIS ENDORSEMENT CHANGES THE POLICY. P - ADDITIONAL INSURED - MANAGERS OR- LESSORS OF ADDITI PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): Sae Y Govemme t Agency or Subdivision Gilroy Political 2. Name of Person or Organization (additional Insured): state or fficials, employees and volunteers are included as Additional Insured Subdivision, City of Gilroy, its o 3. Additional Premium: 0 {If no entry appears above, the information required to complete this endorsement will.be shown in the Declarations as applicable to this endorsement.) in the WFi01S AN INSURED (Section 11) ! �i a app a a of the ownership insured maintenance use of that part of thPemis s Schedule but only with respect to liability 9 leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: �. Ahy "occurrence" which takes place after you cease to be a tenant in that premises. s performed by or on behalf of the person or 2. Structural alterations, new construction or demolition operation organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑