COI - YMCA of Silicon Valley - Expires 2021-07-15Client#: 443977
YMCASILIC
ACORDT. CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DDIYYYY)
7/02/2021
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 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 any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
NA: Felicia McAroy
Marsh & McLennan Agency LLC
PHONE
(/ No Ext : 925,482-9337 A/C No): 925-482-9394
Marsh &McLennan Ins Agency LLC
ADDRESS: Felicia.McA_roy@MarshMMA.COm
1340 Treat Blvd #250
Walnut Creek, CA 94597
INSURER(S) AFFORDING COVERAGE I NAIC #
INSURER A. United States Fire Insurance Company 21113
INSURED
YMCA of Silicon Valley
INSURER B : North River Insurance Company 21105
80 Saratoga Avenue
Berkshire Hathaway 20044
INSURER C : Y Homestate Ins Co
INSURER D :
Santa Clara, CA 95051
INSURER E :
INSURER F :
U Vr- tAUr-b CERTIFICATE NUMBER: 129=11 MKI NrIRAQeo.
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.
LTRR
OF
----------TYPE __ OF -INSURANCE
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE I—XIU OCCUR
ADDL'SUBR
jINSR
X
!WVD
POLICY NUMBER
POLICY EFF POLICY EXP
(MDD/YYYY),(MM/DD/YYYY)
7/01 /2020 07/155/2021
__ LIMITS
EACH OCCURRENCE
DAMAGE TO RENTED
PREMISES Ea occurrence
S 1,QOQ,000
A
_ _M/
5068993644
_
$1 000 000
X PD Ded: $25,000
MED EXP (Any one person)
S10 000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:PRO- 1
X POLICY JECT _i LOC
OTHER: _ _
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X AUTOS ONLY X IRNON-OWNED
AUTOS ONLY
S3,000,000
1
I
5068993644
7/01 /2020 07/15/2021
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
S 1,000,000
Ea accident)B5SINGLE LIMIT
S
1,000,000
A
BODILY INJURY (Per person)
is
BODILY INJURY (Per accidenl)�
PROPERTY DAMAGE
Per accident
S
S
$
B
X UMBRELLA LIAR X OCCUR
EXCESS LIAR CLAIMS MADE
DED X r RETENTION SO
5821144335
7/01/2020 07/15/2021
EACH OCCURRENCE
AGGREGATE
-- — - - -
S1 OOO OOQ
---
$1 000 00O
S
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
OFFICER/MEMBER EXCLUDED? [ N
Mandatory in N
I
1I yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
YMWC202071
7/01/2021 07/01/202
f
- -
ER OTH-
X PSTATUTE IER
E.L. EACH ACCIDENT__
E.L. DISEASE - EA EMPLOYEE
$12 00,000
S1,000,000
E.L. DISEASE - POLICY LIMIT l S1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
RE: Event on 10/01/2017 to 09/30/2021, Child and Adult Care Food program (CACFP) and Summer Food Service
Program (SFSP), Gilroy Youth Center, 227 IOOF Ave., Gilroy, CA 95020.
City of Gilroy, its agents, officers and employees are included as Additional Insured (General Liability),
per the attached.
v—... is wry. L. . wa-6#5-1i UANtor-LLA I IUN
City of Gilroy, Recreation
Department
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
L�/Vvlt1
ACORD 25 (2016/03) 1 of 1
#S8470605/M8452261
O 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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