COI - Bay Area Community Health - Expires 2024-06-01A� o® CERTIFICATE OF LIABILITY INSURANCE
DATE
E/12023Yrv)
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 rights to the certificate holder in lieu of such endorsement(a).
PRODUCER
Arthur J. Gallagher Risk Management Services, LLC
500 N Brand Boulevard, Suite 100
Glendale CA 91203
CONTACT
NAME: Brenda Alda e
PHONE t 818.539-8802 FAX No:818-539-8702
fmc. No
E-MAIL
ADDRESS: Brenda Alda a a' .Coro
INSURERS AFFORDING COVERAGE
NAICA
INSURER A: Pr0AssuranceSpecialty Insurance CO Inc
10179
Llomrsa# OD69293
INSURED TRLHEA41
INSURER B
Bay Area Community Health
40910 Fremont Blvd.
INSURERC:
INSURER D:
Fremont, CA 94538
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 645784105 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
LTfl
OF INSURANCE
ADDLSTYPE
SR
JIMU
POLICYNUMBER
MNDDfYYYY Y EFF
POLICY
LIMITS
COMMERCIAL GENERALUASIUTY
EACH OCCURRENCE
$
CLAIMS -MADE OCCUR
PREMISES Ea occumencei
S
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
If
POLICY jECT LOC
PRODUCTS - COMP/OP AGG
$
S
OTHER:
AWOMOBILEUABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTO$
BODILY INJURY (Per aodden0
$ _
PROPERTYDAMAGE
Per acciffer,t
HIRED NON -OWNED
AUTOS ONLY AUTOSONLV
$
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED RETENTION$
If
WORKERSCOMPENSATION
AND EMPLOYERS' LIABILITY Y/N
I PER
STATUTE ERH
ANYPROPRIETOR/PARTNERIEXECUTIVE
OFFICERIMEMBEREXCLUDEDT
N/A
E.L EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
-- —
$
(MandaloryinNH)
If as, descnbe umier
DESCRIPTIONOFOPERATIONSbatm
E.L. DISEASE -POLICY LIMIT
"---
$
A
Professional Liability/E&O
736420
6/1/2023
6/1/2024
Per Claim
$1,00D,000
Reba Date: 11/15/1984
Claims -Made form
AV9re$ate
$3,000,000
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarl s SChadule, may be attached if more space is required)
Evidence of insurance.
MFFICE
CERTIFICATE HOLDER CANCELLATION
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.
Housing and Community Development Program
AAUT'H�OARIZE.OREP SENTATIVE
7351 Rosanna Street
Gilroy CA 95020
I�IIVJLL► .,
C 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD
Arthur J. Gallagher Risk Management Services, LLC
500 N Brand Boulevard, Suite 100
Glendale CA 91203
MDG2023 00010989 01
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511,
CITY OF GILROY
Housing and Community Development Program
7351 Rosanna Street
Gilroy, CA 95020
We are providing you with a Certificate of Insurance confirming our client's coverage.
Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving
digital copies of certificates via e-mail in the future. Or, do you no longer require a
certificate of insurance for our client? Please contact us at
COI.UpdateMyEmail@AJG.com and provide the following information for processing:
1. Confirmation that a certificate of insurance is no longer required; or
2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery
3. Insured Code: TRI-HEA-01
4. This Certificate Number: 645784105
To learn more about the Insurance and Risk Management Services offered by Gallagher,
please visit us at www.ajg.com/us/about-us/how-we-work/core-360.
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