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HomeMy WebLinkAboutTheater Angels' Art League - Insurance Certificate (Garden)GILRDEM -01 BROOKE .�►CORV° CERTIFICATE OF LIABILITY INSURANCE � °A 111120"�'I'I' 5/11 /2017 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 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 License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 408-642 -2131 NNAAME: Brooke Alarcon, CISR PHONE FAX A/c No Mal: A/C No): A��: balarcon @pdins.com Morgan Hill, CA 95037 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A:MaXum Indemnity Company EACH OCCURRENCE $ 1 ,000,000 INSURED INSURER B: $ 100.000 INSURER C: MED EXP (Any one person) Gilroy Demonstration Garden Gilroy Farmers Market 7360 Eigleberry Street INSURER D PERSONAL & ADV INJURY $ 1,000,000 Gilroy, CA 95020 INSURER E: $ 2,000,000 INSURER F: $ Z0001000 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 POLIICIIUEBS.. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMM/UDD � MAD YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE lxl OCCUR X BDG3002223 -05 06/01/2017 0610112018 EACH OCCURRENCE $ 1 ,000,000 PREMISES Eaoccurrence $ 100.000 MED EXP (Any one person) $ 1,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ Z0001000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per, person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ Is WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? r (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E-L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Gilroy Farmers Market The City of Gilroy, Its Officers, Representatives, Agents and Employees are named as additional insured per policy endorsement form CG2026 0413; copy of forth to follow. GCK 111-1%rA 1 t MULUGK GANGtLLA I IVN City of Gilroy 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 n 1988 -2f)1A ACDRD CCRPCRATION_ All rinhfa rataarvael ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BDG- 3002223 -05 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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):. City of Gilroy, its Officers, Representatives, Agents and Employees 7351 Rosanna Street Gilroy, CA 95020 I 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1 GILRART -01 AMANDA .4COm® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 10/31/2016 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 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 endomement(s).. PRODUCER License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 408- 842 -2131 NcAMEACT Amandaiink, CISR, CLCS PHONE FAX A/c No Ext : AIC, Not -- ADOARkSs: alink@p4ins.com - Morgan Hill, CA 95037 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Nonprofits' Ins Alliance of CA 11845 $ 1,000,000 INSURED INSURER B: X INSURER C: $ 20,006 Gilroy Arts Alliance Dia Hoshida 7341 Monterey Street INSURER D: j PERSONAL & ADV INJURY INSURER E: GEN'L Gilroy, CA 95020 INSURER F: $ 2,000,000 X' 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. INTR TYPE OF INSURANCE NSD WVD POLICY NUMBER MM /D YD/YEYYY MM/DD YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR HNOA X 2016 - 06219 -NPO 10/24/2016 10_/2412017. EACH OCCURRENCE $ 1,000,000 PREMISES Eaoccurrence $ 500,000 X MED EXP (Any one person) $ 20,006 _ j PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES 'PER: POLICY JECT LOC OTHER: _ .. _ GENERAL AGGREGATE _ _ $ 2,000,000 X' PRODUCTS - COMPfOP AGG , $, _ 2,000,000 $ AUTOMOBILE LLA131UTY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LU16 EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICFR/MEM11ER EXCLUDED? ! i (Mandatory in NH) If yyes, describe under DESCRIPTION OF OPERATIONS below N f A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE — $ E.L. DISEASE - POLICY'LIMIT ; $ DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Renarks Schedule, may be attached If more space is required) City of Gilroy, its officers, officials and employees are named as additional insureds on the General Liability Policy where required by written contract. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2014/01) 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 3 ©1988 -2014 ACORD The ACORD name and logo are registered marks of ACORD All rights reserved GILRO14 OP ID: SG ACOR ®" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 09117/2014 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(les) must 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 - "" Phone: 408 -842 -2131 Pacific Diversified Insurance Gilroy Office Fax: 408 -842 -0867 9015 Murray Avenue #110 Gilroy, CA 95020 Pacific Diversified Insurance CONTACT NAME: Brooke Alarcon PHONE FAx aC Ne ,, ,:408-842-2131 ac No): 408- 842 =0867 App ess; balarcon dins.com . INSURE S AFFORDING COVERAGE NAIC # INSURER A:Maxum Indemnity Company X INSURED Gilroy Demonstration Garden Gilroy Farmers Market 7360 Eigleberry Street Gilroy, CA 95020 INSURER 0: 06101/2014 INSURER C: EACH OCCURRENCE INSURER D: PREMISES Ea occurrence INSURER E: MED EXP (Anyone person) INSURER F : PERSONAL & ADV INJURY' 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 POLICY NUMBER POLICY.EFF MM/D .POLICY EXP MM/DD LIMITS A .17. GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X BDG3002223 -02 06101/2014 06101/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Anyone person) $ 5,000 PERSONAL & ADV INJURY' $ 1,000,000 GENERAL AGGREGATE, 1. $ 2,000;000 GEN'L'AGGREGATE LIMIT APPLIES PER: POLICY F7 PRO LOC PRODUCTS'._ COMP /OP AGG $ 21600,00C $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY ,INJURY (Per accident) $ PROPERTY DAMAGE Pet accident $ UMBRELLA LAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE '. $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? I (Mandatcq in NH) . — If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- '0TH - IQRY ' LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION .OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Gilroy, its officers, officials and employees are named as additional insureds per the attached endorsement. City of Gilroy 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 reserved.. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BDG 3002223 -02 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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): City of Gilroy, its Officers, Representatives, Agents and Employees 7351 Rosanna Street Gilroy, CA 95020 I 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. Wdh respect to the insurance afforded to these additional insureds, the following is added to Section 111 — 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 OP ID: VB ^t>~�,.°-Rt' CERTIFICATE OF LIABILITY INSURANCE °A 061011 "'"Y' 06101111 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 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 408- 842 -2131 Pacific Diversified Insurance 40"42-0867 Gilroy Office 9016 Murray Avenue #1110 Gilroy, CA 96020 Pacific Diversified Insurance CONTACT ONE Mntl WAR CiILR014 D INSURERIS11 AFFORDINO COVERAGE NAIC H INSURED Judy Hess dba INSURERA:MBXum Specialty Ins Group $ 1,000,00 Gilroy Demonstration Garden Spice of Life Farmers Market 777 First Street #260 INSURER 8: X INSURER 0, BDG0057003 -01 INSURER D: 06/01/12 Gilroy, CA 95020 INSURER E: MED EXP(Any one person ) $ 6,00 PERSONAL& ADV INJURY S 1,000,00 COVERAGES CFRTIFICATF SFIIMRF'R: RF1IISIr1M M1111rngm. 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. N R TYPEOF INSURANCE APUL =1513 POLIGY.NUMBER ( E LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 1,000,00 A X COMMERCIALGENERALLIADILITY L'LAIM &MADE OCCUR X BDG0057003 -01 06/01/11 06/01/12 PREMISES ERaoo unence s �~ 60,00 MED EXP(Any one person ) $ 6,00 PERSONAL& ADV INJURY S 1,000,00 GENERALAGGREGATE $ 2,000,00 GENT. AGGREGATE LIMrr APPLIES PER: PRODUCTS - COMP /0P AGG $ 1,000,00 POLICY PRO. LOO $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ee awident) $ BODILY INJURY IPor person) $ ALL OWNED AUTOS BODILY INJURY (Per a ccident) S�� _ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACHOCCURRENCE $ EXCESS Lt AB CLAIMS -MADE _ AGGREGATE $ DEDUCTIBLE $ $ RET N I WORKERS COMPENSATION AND E..MPLOYERV LIABILITY Y 1 ANY PROPRIFTOR)PARTNEWEXECUTNE OFFICERIMEMBERFXCLUDED7 NIA WCSTA U- OTH- LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE$ (MandoWty in NH) If s, desodbe under DO OR fP ON OF O E . DISEASE - POLICY LIMIT DESCRIPTION OF 0 ERATIONS f LOCATIONgg 1 V HICLES (Afhtch ACORD 104, gqdditlonal Remarke Schedule, If more apace Is required) Cergficate holler is named as additional intsured per attaNded endorsement, City of Gilroy 7361 Rosanna Street Gilroy, CA 96020 SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELMED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 81988 -2009 AGORD zO (21109109) The ACORD name and logo are registered marks of ACORD All rights Sierra Specialty insurance Services, Inc. B I N D E R 389 Clovis Ave. Suite 100 Clovis, CA 93612 CA License #: OEOI019 Policy No. provious Nn. Phones (559)256 -6900 Fax: (559)256 -6950 BDG0057003 -01 Named Insured; JUDX HESS GILROY DEMONSTRATION GARDEN SPICE OF LIFE FARMERS MAR= 777 FIRST STREET 0260 GILROY CA 95020 VICKIS BAROF.L PACIFIC DIVERSIFIED INS AM Hest Name of Insurers) 9015 Murray Ave., Ste 110 A -VII MAXUM INDEMNITY COMPANY 100`8 GILROY CA 95020 Fax; (400) 042 -6212 Binder Effective: 06- 01-11 to 07-01 -11 Policy Effective: 06 -01 -11 to 06 -01 -12 12:01 A.H, standard Time Maxum Indemnity Insurance Company Coverage; Commercial. General Liability Limit of Liability: General Aggregate Limit (Other Than Prods /Compl Ops) $2,000,000 Products /Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Damage to Premises Rented to You Limit (Any One Premises) $ 50,000 Medical Expense Limit (Any One Person) $ 5,000 TRIA: $26.40 (Additional plus 3.250% taxes & fees) ( } TRIA Accept: (X) E745 Disclosure Notice ()f) E739 Amendment -- War /Terrorism (X) TRIA Reject: (X) )x743 Exclusion War /Terrorism Terms and Conditions: (X) Pi Policy Jacket with Policy Conditions (X) DECC Common Policy Declarations (X) 9040 Minimum Earned Premium (25g) (X) 0142 Service of Suit - California (X) DECECL Commercial General Liability Coverage Part. Declarations (continued on page 2) PREMIUM 4660.00 Broker Fee $150.00 Surplus Lines Tax $19.80 Stamping Fee $1.65 TOTAL $831.45 ONDITIONS: The Insurers bind the kind(s) of insurance stipulated above, This insurance is ubject to the terms, conditions and limitations of the policy(ies) in current use by the nsurers, This binder may be cancelled by the insured by surrender of this binder or by ritten notice to the Insurers stating when cancellation will be effective. This binder may e cancelled by the Insurers by notice to the Insured in accordance with the policy condition. his binder is cancelled when replaced by a policy. If this binder is not replaced by a olicy, the Insurers are entitled to charge a premium for the binder according to the rules ad rates in use by the Insurers. Data June 1, 2011 Authorized Representative. (OMNI70CDG0M050G41H1GDG1oe37) ORIGINAL Copy Contact: CATHY TEMPLE OP ID- % CERTIFICATE OF LIABILITY INSURANCE DATE(MMiDD/YYYY) 06101111 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS r CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. 15XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS }, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must 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 408.842 -2131 CONTACT Pacific Diversified Insurance PHONE Office A08- 842 -0867 -(No A 9016 Murray Avenue #110 E•MAM Gilroy, CA 96020 PROou o; Pacific Diversified Insurance aMER ros GILR 114 INSURED Judy Hess dba INSURERA:MUXUm Specialty Ins Group Gilroy Demonstration Garden INSURER B: Spice of Life Farmers Market INSURER C: 777 First Street #260 Gilroy, CA 95020 INSURER D: INSURER E: lWatMOR P! CAVDDEfSCQ nsro•nrrnnrr nn tnnorn. 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 TYPEOFINSURANCE APIP Will U E P I LIMITS GENERAL LIABILITY EACHOCCURRENCE $ 1,000100 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MAOE Q OCCUR X BDG0057003 -01 08/01/11 06/01112 PREMISES Eaocgurrenoo _ $ 60,00 MED EXP (Any one person $ 6,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT- AGGREGATE LIMIT APPLIES PER: POLICY PRO• LOC PRODUCTS - COMPIOP AGG $ 1,0()0,00 $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea acoldenQ ^ $ BODILY INJURY (Par person) $ ALL OWNED AUTOS ' BOOILY INJURY (Per axldenQ S _ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (POr accidenq $ NON -OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADG AGGREGATE $ DEDUCTIBLE $ S RE1' N I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y NN ANY PROPRIETORIPARTNER/EXECUTNE OFFICERWEh1BEREXCLUDED? u NIA WCSTA U- OTH- LI _ E.LEACNACCIDENT $ E.L OISEASE-EA EMPLOYE $ (Mandatary b 1. Nn ) It e, dssorlbe under E.L- DISEASE - POLICYLIMIT IP ON DESCRIPTION OF O ERATIONS 1 LOCATION ) V HICLE (Athteh ACORD 104, tldltlonal Remarks Schadille, It more space Is rorIalred) Certificate holder is named as ac dit�on.1 nsured per attac; eed endorsement, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE Df6_IVERPD IN 7361 Rosanna Street ACCORDANCE WITH THE POLNCY PROVISIONS. Gilroy, CA 96020 AUTHORIZED REPRESENTATIVE r -d '�_t 0 1988 -2009 Ma'wrcu <a (cuuvruvi The AGURD name and logo are registered marks of ACORD reserved, Sierra Specialty insurance Services, Inc. BINDER 389 Clovis Ave. suite 100 Clovis, CA 93612 CA License #: OC81O19 Policy No. Previous No. i Phones (559)256 -6900 Fax: (559)256 -6950 BDG0057003 -01 Named Insured: JUDY HESS GXLROY 09HONSTRATION GARDEN SPICE OF LIFE rARMGRS MARKS 777 FIRST STREET #260 GILROY CA 95020 VICKIE BAPOFF PACIFIC DIVERSIFIED INS AM Best Name of Insurer(a) 9015 Murray Ave., Ste 110 A -VII MAXUM INDEMNITY COMPANY 100% GILROY CA 95020 Fax: (400) 842 -6212 Binder Effective: 06- 01-11 to 07 -01 -11 Policy Effective: 06-01 -11 to 06 -01 -12 12 :01 A.M. standard Time Maxum Indemnity Insurance Company Coverage: Commercial. General Livability Limit of Liability: Gonaral Aggregate Limit (Other Than Prods /Compl Opa) 52,000,000 Products /Completed Operations Aggregate Limit $1,000,000 Personal and Advertising Injury Limit $1,000,000 Each Occurrence Limit $1,000,000 Damage to Premises Rented to You Limit (Any One Premises) 0 50,000 Medical Expense Limit (Any One Person) $ 5,000 TRIA: $26.40 (Additional plus 3.250% taxes & fees) ( } TRIA Accept,: (X) E745 Disclosure Notice (X) B739 Amendment -- War /Terrorism (X) TRIA Reject: (X) L743 Exclusion War /Terrorism Terms and Conditions: (X) Pi Policy Jacket with Policy Conditions (X) DECC Common Policy Declarations (X) E046 Minimum Earned Premium (25W) (X) 9142 Service of Suit - California (X) DECECL Commercial General Liability Coverage Part Declarations (continued on page 2) PREMIUM $660.00 Broker Fee $150.00 Surplus tines Tax $19.80 Stamping ree $1.65 TOTAL $831.45 ONDITION3: The insurers bind the kind(s) of insurance stipulated above, This insurance is ubject to the terms, conditions and limitations of the policy(ies) in current use by the nsurers, This binder may be cancelled by the insured by surrender of this binder or by ritten notice to the Insurers stating when cancellation will be effective. This binder may e cancelled by the Insurers by notice to the Insured in accordance with the policy condition. his binder is cancelled when replaced by a policy. If this binder is not replaced by a olicy, the Insurers are entitled to charge a premium for the binder according to the rules ad rates in use by the Insurers. Date June 1, 2011 Authorized Representative: (OMNI70000A0 -05080111100010837) ORIGINAL Copy Contact: CATHY TEMPLE