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Sheryl Cathers - Insurance Certificate (2019)A ® SAL CERTIFICATE OF LIABILITY INSURANCE 8022 DATE(MM/DD /YYYY) 10/2/2018 THIS CERTIFICATEIS 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 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 PACIFIC DIVERSIFIED INS SVCS /PHS 152358 P: (866) 467 -8730 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: n"c °,No,Ext): (866) 467 -8730 iAic,No): (888) 443 -6112 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Sentinel Ins Co LTD 11000 INSURED DABBLE ART CENTER 7680 MONTEREY ST STE 106 GILROY CA 95020 INSURER B COMMERCIAL GENERAL LIABILITY INSURER C INSURER D: INSURER E: EACH OCCURRENCE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICYEFF M1IMIDD POLICY EXP l LIALITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1, 000, 0 0 0 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1, 000, 0 0 0 X X MED EXP (Any one person) $10, 000 A General Liab 57 SBA BH7094 08/30/2018 08/30/2019 PERSONAL & ADV INJURY $1, 000, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2, O O 0 , 000 POLICY E7 PECOT- ❑X LOC PRODUCTS - COMP /OP AGG s2, 000, O O O OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1 000, 000 I BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 57 SBA BH7094 08/30/2018 08/30/2019 X BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION s $ B'ORKERS COMPENSA TION AND EMPLOYERS' LIABILITY PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ❑ WA E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT S DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. City of Gilroy , its officers, representative, agents, and employees is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City of Gilroy , its Officers BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Representative, Agents, and Employees 7351 RO S ANNA ST AUTHORIZED REPRESENTATIVE GILROY, CA 95020 © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBA BH7094 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION CITY OF GILROY 7370 ROSANNA ST GILROY, CA 95020 LOC 001 BLDG 001 CONNECITNG WATERS CHARTER SCHOOL 21420 BENTLEY ST. WATERFORD CA 95386 Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001 Process Date: 06/13/18 Expi ration Date: 08/30/19 Rachel Munoz From: Services, Agency (Comm Lines, San Antonio /SCIC) < Agency.Service @thehartfo rd. com> Sent: Tuesday, October 02, 2018 2:10 PM To: Rachel Munoz Subject: RE: DABBLE ART CENTER Attachments: City of Gilroy Cert.pdf; City of Gilroy Endorsement.pdf Good Afternoon, Attached is the Certificate Of insurance. If you have any question or concerns, please do not hesitate to call us. Thank you, Shawn Lagasse Customer Relationship Specialist Business Insurance Service Operations THE HARTFORD The Hartford Financial Services Group, Inc. Business I ,.n 1 Griffin Road North Windsor, CT 06006 Employee Pene6ta P: 866 - 467 -8730 Auto F: 888 - 443 -6112 Home Email: agency .services(a.thehartford.com www.thehartford.com www.facebook.com /thehartford www.twitter.com /thehartford Register today at www.thehartford.com /servicecenter and discover the ease of paying your bill, enrolling in AutoPay, requesting certificates of insurance, viewing documents or Going Paperless. We care about meeting your service expectations. Did I provide you with a great Hartford Experience? Please feel free to send any feedback on my service to David.Bryon @thehartford.com This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential and /or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return e-mail, delete this carmnunication and destroy all copies. THE HARTFORD Policy number 57- SBA- BH7094 DABBLE ART CENTER AGENCY NANIE : PACIFIC DIVERSIFIED INS SVCS /PITS Producer Code 57152358 To whom this may concern, The following insured DABBLE ART CENTER, does not carry Workers' Compensation Insurance through The Hartford. Please do not reply to this E -mail directly. Thank you. Your Hartford Services Team, (877)853 -2582 (Agency Callers) (866)467 -8730 (Policyholders) Agency. Services(u�TheHartFord.com (All Customers) L� Rachel Munoz From: Sheryl Cathers <sherylcathers @me.com> Sent: Wednesday, September 26, 2018 1:18 PM To: Rachel Munoz Subject: Insurance To- City of GIlroy, Police Dept Re- anti graffiti artwork This is to confirm that I am self employed as sole proprietor of dabble Art Center. I do not have any employees and therefore do not offer workers compensation. Thank You, Sheryl Cathers Dabble Art Center 7680 Monterey St. Suite 106 Gilroy, CA 95020 408 427 -2204 URL: dabbleartcenter.com N M O R M O V O f2 O co N co O N U) v 0 0 O 7 GEICOD Tel: 1- 800 -841 -3000 ge1co.com GEICO GENERAL INSURANCE COMPANY P.O. Box 509090 San Diego, CA 92150 -9090 Date Issued: June 22, 2018 JEFFERY C CATHERS AND SHERYL A CATHERS 5875 MILLER AVE G I LROY CA 95020 -6807 Email Address: jcathers1 @me.com Named Insured Jeffery C Cathers Sheryl A Cathers Vehicles 1 2013 Toyota Tacoma --------------------------------------------------------- 2 2007 Volks Rabbit Coverages* Bodily Injury Liability VIN Declarations Page This is a description of your coverage. Please retain for your records. Policy Number: 4520- 85 -89 -13 Coverage Period: 06 -04 -18 through 12 -04 -18 Your coverage begins and ends at 12:01 am local time at the address of the named insured. Endorsement Effective: 06 -22 -18 Additional Drivers None Vehicle Location 3TMLU4EN3DM113151 Gilroy CA 95020 ------ - - - - -- ----------------------- WVWAS71 K97WO53715 Gilroy CA 95020 Limits and /or Deductibles Each Person /Each Occurrence $15,000/$30,000 State Minimum ,000/$30,0000 ------------------------------------$15----------------------------------------------------------------------------------------------------------------------------- Property Damage Liability $5,000 State Minimum $5,000 Uninsured & Underinsured Motorists Each Person /Each Occurrence $15,000/$30,000 Uninsured Motorists Property Damage '$3,500 - - Comprehensive - - - - -- -- - - - - -- --- - - - - -- $500 Ded - - - -- - - ----- - - - - -- -- - - - -- - - - - -- -- - - -- Collision $500 Ded Six Month Premium Per Vehicle Total Six Month Premium *Coverage applies where a premium or $0.00 is shown for a vehicle. Finance Company/ Lienholder Wells Fargo Dealer Svcs Vehicle 1 $48.90 Vehicle 2 $53.40 ------- - ---- --------------- ------------------------------------- $79.60 $88.80 $11.30 $11.90 ------ - - - - -- $3.90 ------------------------------ --------------------------------- $23.00 - -- -- -- - - - - -- - - - -- - - - - - -- -------------- - - - -- --- - - - - -- $148.80 - $311.60 $158.00 $469.60 If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee amount will be shown on your billing statements and is subject to change. DEC—PAGE (03 -14) (Page 1 of 2) Continued on Back Policy Change Page 5 of 12 Discounts Multi -Car (All Vehicles) Subclass Factor (All Vehicles) Anti -Theft Device (Veh 1) California Good Driver (All Vehicles) California Persistency (All Vehicles) Group Insurance Plan: Professional Group Insurance Plan Contract Type: A30CA Contract Amendments: ALL VEHICLES - A30CA A54CA Unit Endorsements: UE316C (VEH 1); A426 (VEH 2) Class: A -N -34MF Z (VEH 1); A -M -34MM G (VEH 2) Important Policy Information -No coverage is provided in Mexico. - Reminder - Physical damage coverage will not cover loss for custom options on an owned automobile, including equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported to us. This reminder does NOT apply in VIRGINIA, however, in Virginia coverage is limited for custom furnishings or equipment on pick -up trucks and vans but you may purchase coverage for this equipment. Please call us at 1- 800 - 841 -3000 or visit us at geico.com if you have any questions. -You have elected to receive your insurance documents via electronic delivery at the following electronic mail address: jcathers1 @me.com. To change the address where you receive your policy documents, visit geico.com, or call 1- 800 - 841 -3000. - Congratulations! Your policy qualifies for the Professional Group Insurance Plan and includes a savings of $103.40. -In accordance with Section 1872.87 of the California Insurance Code, in addition to your premium, a $0.88 charge per vehicle is assessed to fund auto insurance fraud reduction initiatives. This charge is applied once per policy term per vehicle. -A credit or discount has been applied to this policy: Multi -Car. -The 2007 VOLKS has been added to your policy. DEC_PAGE (03 -14) (Page 2 of 2) Policy Change Page 6 of 12 '�'���C,h California Evidence of Liability Insurance 1- 80048 -3000 901110 .040M _......... GEICO GENERAL INSURANCE COMPANY PO BOX 509090 SAN DIEGO, CA 92150-! NAIC Code: 35882 Policy Number Effective D 4520858913 06 -04 -48 Year Make 2013 TOYOTA Insured: JEFFERY CARL AND SHERYL ANNE CATHERS 5875 MILLER AVE GILROY, CA 95020 -6807 Expiration Date 12 -04 -18 Vehicle ID No. 3TMLU4EN3DM113151 Evidence of Insurance Here are your Evidence of Liability Insurance Cards. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time $2,000 for additional times Also, a Judge can have your vehicle Impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. The coverage provided by this policy meets the minimum requirements of sections 16056 & 16500.5 of the Caldomia Due to space limitations on the I D card, only the Vehicle Code, minimum liability limits prescribed by law. Named Insured and the Co- insured are listed. For a full list of drivers covered under this policy, please reference the Drivers section of your Declaratlons Page,which is included with your insurance packet. If you would like additional ID cards you can go online to geico.com or call us at 1- 800 - 841 -3000. What to do at the time of an accident. • Do not admit fault. • Do not reveal the limits of your liability coverage to anyone. • Exchange contact information; get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1- 8ee -841 -3000 or visit geico.com to report the accident. U -4 -CA (11 -09)