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HomeMy WebLinkAboutCOI - Youth Alliance - Expires 2026-11-05SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION$ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/30/2025 CalNonprofits Insurance Services 1500 41st Avenue,Suite 228 Capitola CA 95010 Samantha Ibarra 831-824-5022 samantha@cal-insurance.org Nonprofits Insurance Alliance of California 10023 HOLLYOU-01 Republic Indemnity Company of America 22179YouthAlliance 310 Fourth Street,Ste 101 Hollister CA 95023 842794663 A X 1,000,000 X 500,000 20,000 1,000,000 3,000,000 X Y 01-CP-0006291-01-21 11/5/2025 11/5/2026 3,000,000 A 1,000,000 X X Y 01-CP-0006291-01-21 11/5/2025 11/5/2026 1,000,000 A X 2,000,000 X 01-UB-0006291-01-06 11/16/2025 11/16/2026 2,000,000 B X257958016/1/2025 6/1/2026 1,000,000 1,000,000 1,000,000 A A A Accident Liability Directors &Officers Social Service Professional 07-AC-0006291-01-03 01-CP-0006291-01-21 01-CP-0006291-01-21 11/16/2025 11/5/2025 11/5/2025 11/16/2026 11/5/2026 11/5/2026 Policy Aggregate Each Claim/Aggregate Each Claim/Aggregate $1,000,000 $1M/$1M $1M/$3M Improper Sexual Conduct and Physical Abuse Liability:Nonprofits Insurance Alliance of California,NAIC#10023,Policy Number:01-CP-0006291-01-21, Effective Dates:11/05/2025 to 11/05/2026,Each Claim/Aggregate:$1M/$1M Liquor Liability:Nonprofits Insurance Alliance of California,NAIC#10023,Policy Number:01-CP-0006291-01-21,Effective Dates:11/05/2025 to 11/05/2026, Each Cause/Aggregate:$1M/$1M The City of Gilroy,its officers,representatives,agents and employees are included as Additional Insured with respect to General Liability,Business Auto Liability and Social Service Professional Liability as required by written contract per Endorsement Form(s)CG 20 26 12 19,NIA-102 BA 01 25 and NIA-002 SSP 03 25 attached.30 Day Notice of Cancellation applies per Endorsement Form(s)NIA-064 GL 10 12 attached. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 Docusign Envelope ID: 1EB05AFB-4B77-4D25-BCDF-7E1A3122D0C0 NIA-064 GL 10 12 Nonprofits Insurance Alliance™ and NONPROFITS OWN® are brands of Alliance Member Services™ (AMS). © AMS. All rights reserved. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AMENDED NOTICE OF CANCELLATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Cancellation: 30 Days Notice of Cancellation Person or Organization: City of Gilroy If we cancel this policy for any statutorily permitted reason other than nonpayment of premium, we will mail notice of cancellation to the person or organization shown above. We will mail such notice to the address shown at least the number of days shown for cancellation. Docusign Envelope ID: 1EB05AFB-4B77-4D25-BCDF-7E1A3122D0C0 NIA-102 BA 01 25 Nonprofits Insurance Alliance™ and NONPROFITS OWN® are brands of Alliance Member Services™ (AMS). © AMS. All rights reserved. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AI - PRIMARY AND NON-CONTRIBUTARY – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM In consideration of the premium charged, it is understood and agreed that the following is added as an additional insured: Any person or organization that you are required to include on this policy, under written contract or agreement currently in effect or becoming effective during the term of this policy, applicable under the terms and conditions of this endorsement, and consistent with the description below that the parties intend. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) But only as respects a legally enforceable contractual agreement with the Named Insured and only for liability arising out of the Named Insured's negligence and only for occurrences of coverages not otherwise excluded in the policy to which this endorsement applies. It is further understood and agreed that irrespective of the number of entities named as insureds under this policy, in no event shall the company's limits of liability exceed the occurrence or aggregate limits as applicable by policy definition or endorsement. Such insurance as is afforded by this endorsement for the additional insured shall apply as primary insurance. Any other insurance maintained by the additional insured or its officers and employees shall be excess and non- contributing with the insurance afforded by this endorsement. Docusign Envelope ID: 1EB05AFB-4B77-4D25-BCDF-7E1A3122D0C0 POLICY NUMBER: 01-CP-0006291-01-21 COMMERCIAL GENERAL LIABILITY CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1.In the performance of your ongoing operations; or 2.In connection with your premises owned by or rented to you. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1.Required by the contract or agreement; or 2.Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Docusign Envelope ID: 1EB05AFB-4B77-4D25-BCDF-7E1A3122D0C0 NIA-002 SSP 03 25 Includes copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED – PRIMARY AND NON-CONTRIBUTORY - FOR DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: SOCIAL SERVICE PROFESSIONAL LIABILITY COVERAGE FORM SCHEDULE Section III of the Social Service Professional Liability Coverage Form — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule in this endorsement, but only with respect to liability for "damages” caused solely by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations. Section 4 of the Social Service Professional Liability Coverage Form (Claims-Made) — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule in this endorsement, but only with respect to liability for "damages” caused solely by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations. The insurance extended by this endorsement is primary coverage when you have so agreed in a written contract or agreement and will be considered non-contributory with the additional insured(s) own insurance. Name Of Additional Insured Pe rson(s) Or Organization(s): Any person or organization that you are required to add as an additional insured on this policy, either under a written contract or agreement currently in effect or becoming effective during the term of this policy. However, the additional insured status will not be afforded with respect to liability arising out of or related to your activit ies as a real estate manager for that person or organization. Docusign Envelope ID: 1EB05AFB-4B77-4D25-BCDF-7E1A3122D0C0