Miller Red Barn - Insurance Certificate,4coR ®® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMDDnYYr)
09/15/2017
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 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
CONTACT
NAME gill Slebe
AX No
(408) 776 -8600 IF
SL Insurance Associates
ADDRESS bell @sllnsure COm
ADDRL
275 Tennant Ave #207
INSURER (S) AFFORDING COVERAGE
NAIC #
INSURER A GREAT AMER INS CO
16691
Morgan HIII CA 95037
INSURED
INSURER B
CLAIMS -MADE FR OCCUR
INSURER C
Miller Red Barn Committee
INSURER D
INSURER E.
$ 100,000
PO Box 1265
INSURER F:
$ 5,000
Morgan HIII Ca 95038
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
INSR
LTR
TYPE OF INSURANCE
AD L
VD
POLICY NUMBER
POLICY EFF
MMIDDIIYYYY
POLICY EXP
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE FR OCCUR
PREMISES (EEa occurrence
$ 100,000
MED EXP (Any one person )
$ 5,000
PERSONAL & ADV INJURY
$ 1,000,000
A
Y
Y
GLP 1230477
04126/2017
04/26/2018
GEN'L AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 2,000,000
PRO- FX LOC
X POLICY E]
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
OTHER
AUTOMOBILE
LIABILITY
MBINED INGLE LIMIT
Ea CO nt S accide
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
HIRED AUTOS NON -OWNED
AUTOS
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
HCLAIMS-MADE
AGGREGATE
$
EXCESS LIAB
DIED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
I PER OTH-
STATUTE ER
EL EACH ACCIDENT
$
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
NIA
E L DISEASE - EA EMPLOYE
$
(Mandatory In NH)
tf yes, describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY LIMIT 1
$
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
As It pertains to its California operations, and where required by contract, for all locations in the State of California, the following Is named as Additional Insured
Interest
The City of Gilroy, its officers, representatives, agents, and employee
30 day notice of cancellation
CERTIFICATE HOLDER CANCELLATION
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS.
7351 Rosanna St
Gilroy Ca 95020
@ 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
GREAIA,1 RicAN CG 82 24
(Ed. 12 01)
INSURANCE GROUP
Policy Number: GLP 1230477
GENERAL LIABILITY BROADENING ENDORSEMENT - BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following prov1s1on is added to SECTION
II - WHO IS AN INSURED
5. AUTOMATIC ADDITIONAL INSURED(S)
a. Additional Insured - Manager or
Lessor of Premises
(1) This policy is amended to include as an
insured any person or organization
(hereinafter called Additional Insured)
from whom you lease or rent property
and which requires you to add such
person or organization as an Additional
Insured on this policy under:
(a) a written contract; or
(b) an oral agreement or contract
where a Certificate of Insurance
showing that person or
organization as an Additional
Insured has been issued;
(c) In no event shall the coverages or
Limits of Insurance in this Coverage
Form be in creased by such
contract.
(2) Coverage provided herein is excess
over any other valid and collectible
insurance available to the Additional In
sured whether the other insurance
is primary, excess,
contingent or on any other basis
unless a written contractual arrangement
specifically requires this insurance to
be primary and non - contributory relative
to insurance on which the additional
insured is Named Insured.
(3) This insurance does not apply to:
(a) Any "occurrence" o r offense which
takes place after you cease to be
a tenant in that premises.
(b) Structural alterations, new
construction or demolition
operations performed by o r on
behalf of the "Additional Insured."
2. BLANKET WAIVER OF SUBROGATION
SECTION IV COMMERCIAL GENERAL
LIABILITY CONDITIONS, Item 8. is replaced
with:
8. Transfer of Rights of Recovery Against
Others to us and Blanket Waiver of
Subrogation
a. If an Insured has rights to recover
all or part of any payment we have
made under this Coverage Part,
those rights are transferred t o us.
The Insured must do nothing after
loss to impair them. At our request,
the Insured will bring "suit' or
transfer those rights to us and help
us enforce them.
b. If required by a written "insured contract',
we waive any right of recovery we may
have against any person or organization
because of payments we make for injury
or damage arising out of your ongoing
operations or "your work" done under
contract for that person or organization and
included in the "products- completed
operations hazard."
Includes copyrighted material of Insurance Service Office with its permission.
Copyright, Insurance Services Office, Inc., 2001
CG 82 24 (Ed. 12/0 1) XS