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HomeMy WebLinkAboutTheater Angels' Art League - Insurance Certificate (Building)A ORv,. CERTIFICATE OF LIABILITY INSURANCE OP IDvB DATE(MM /DOIYYYY) 1 THEAT 1 10/27/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pacific Diversified Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gilroy Office HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9015 Murray Avenue #110 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NSRD TYPE OF INSURANCE Gilroy CA 95020 Phone: 408- 842 -2131 Fax: 408 -842 -0867 INSURERS AFFORDING COVERAGE NAIC # INSURED Theater Angels' Art League INSURER A: onpro Eit'a T alliance GENERAL LIABILITY INSURER B: INSURER EACH OCCURRENCE INSURER A 951 Hoesch Gilroy CA 95020 INSURER E: 10/24/10 COVERAGES 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L City of Gilroy. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR POLICY EFFECTIVE POLICY EXPIRATION Gilroy CA 95020 LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY) DATE (MM /DDIVY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X X COMMERCIAL GENERAL LIABILITY 201006219NPO 10/24/10 10/24/11 DAMAGE TO RENTED PREMISES (E. occ.rence) $ 500000 MED EXP(Anyone person) $ 20000 CLAWSMADE F OCCUR PERSONAL S ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2000000 PRO - POLICV JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea ewitlenl) BODILY INJURY a ALL OWNED AUTOS SCHEDULED AUTOS (Per person) BODILY INJURY (Per auidenl) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ (Per acc d-D GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHERTHAN EA ACC $ ANY AUTO $ AUTO ONLY'. AGO EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑ CLAIMS MADE AGGREGATE $ a $ DEDUCTIBLE $ RETENTION $ WC STATU- OTH- WORKERSCOMPENSATIONAND TORY LIMITS_ ER _ EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNEWEXECUTIVE EL. DISEASE - EA EMPLOYEE $ OFFICEWMEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below I I I E L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder is named as additional insured in regards to the property located at 7341 Monterey Street, Gilroy, CA. CERTIFICATE HOLDER CANCELLATION GILRO02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Gilroy. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 7351 Rosanna Street Gilroy CA 95020 REPRESENTATIVES. AUT SE iIVE ACORD 25 (2001/08) C) ACORD CORPORATION 1988 The certificate holder, the city of Gilroy and its officers, agents, employees, and elected officials are named as additional insured in regards to the property identified in the Lease Agreement dated 12/29/09 for the Temporary Arts and Cultural Center. The attached endorsement fully covers this property as required by the Lease Agreement - Single Tenant Lease between the city of Gilroy Landlord as landlord and Theater Angels Art League Tenant as tenant for Premises commonly known as the Old Salvation Army Building and adjacent vacant properties Lease. POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy. 3. Additional Premium: Included (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the prem- ises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑ POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 12 07 98 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Political Subdivision: Any State or Political Subdivision that issues a permit to the named insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured is amended to include as an insured any state or political subdivi- sion shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. This insurance does not apply to: a. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of opera- tions performed for the state or municipality; or b. 'Bodily injury" or "property damage" included within the "products- completed operations hazard ". CG 20 12 07 98 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑ COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE, OR RECEIVER This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organization: Any person or organization acting as a Mortgagee, Assignee, or Receiver with respect to locations scheduled on the policy. Designation of Premises: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 1. WHO IS AN INSURED (Section II) is amended to include as an insured the person(s) or organization(s) shown in the Schedule but only with respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of the premises by you and shown in the Schedule. 2. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. CG 20 18 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 1198 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - CHARITABLE INSTITUTIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. WHO IS AN INSURED (Section II) is amended to include as an insured: 1. Your members but only with respect to their liability for your activities or activities they perform on your behalf; and 2. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf. CG 20 20 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ OP ID: AD 144c°RO CERTIFICATE OF LIABILITY INSURANCE 1 DATE 10 /20DYYYY) 0/20/11 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 terns 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 408 - 842 -2131 Pacific Diversified Insurance 408 - 842 -0867 Gilroy Office 9015 Murray Avenue #110 Gilroy, CA 95020 Pacific Diversified Insurance NAMECT PHONE FAX ac No Ext : A/c, No): ADDRESS: PRODUCER THEAT -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Theater Angels' Art League 951 Hoesch Gilroy, CA 95020 INSURER A:Nonprofit's Insurance Alliance INSURER B: INSURER C INSURER D: INSURER E: 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 LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MMIDD YYYY MMIDD YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 • X COMMERCIAL GENERAL LIABILITY 201106219NPO 10/24/11 10/24/12 DAMAGE TO RENTED PREMISES Ea occurrence $ 500 00 CLAIMS -MADE I OCCUR.. MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 $ . POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ • SCHEDULED AUTOS X HIRED AUTOS 2011- 06219 -NPO 10/24/11 10/24/12 -- — -- -- _ -- PROPERTY DAMAGE (Per accident) $ $ • X NON - OWNEDAUTOS 2011- 06219 -NPO 10/24/11 10/24/12 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN, ANY PROPRIETOR /PARTNER /EXECUTIVE WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ N / A (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2011 - 06219 -NPO COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy. 3. Additional Premium: Included (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the prem- ises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑