Loading...
HomeMy WebLinkAboutYMCA of Silicon Valley - Insurance CertificateClient #: 27430 YMCAOFSI �4CORD. CERTIFICATE OF LIABILITY INSURANCE ATE (MM /DD/ YYYY) DATE 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 Marsh 8r McLennan Agency LLC Marsh 8r McLennan Ins Agency LLC 1340 Treat Blvd #250 Lic OH 18131 Naf"IEACT Felicia McAroy PHONE 925 482 -9300 925 482 -9390 o Ext A/C, No E-MAIL ADDRESS Felicia.McAroy @MarshMMA.com 5068898919 Walnut Creek, CA 94597 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: North River Insurance Company 21105 INSURED INSURER B: United States Fire Insurance Co 21113 YMCA of Silicon Valley 80 Saratoga Avenue Santa Clara, CA 95051 INSURER C. INSURER D PERSONAL 8 ADV INJURY $110001000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY 7 J COT 7 LOC OTHER GENERAL AGGREGATE INSURER E. PRODUCTS - COMP/OP AGG 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 B_ EE_N REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS • X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 5X OCCUR X 5068898919 07/01/2017 07/01/2018 EEpACCryIlH OCCURRENCE $110001000 PREMISES ER occw ence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL 8 ADV INJURY $110001000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY 7 J COT 7 LOC OTHER GENERAL AGGREGATE s3,000,000 PRODUCTS - COMP/OP AGG $1,000,000 $ • AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 5068898919 7/01/2017 07/01/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 5821082127 7/01/2017 07/01/2018 EACH OCCURRENCE $110001000 AGGREGATE $1,000,000 DED I X RETENTION SO $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? FN (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 4087316214 07/01/2017 07/01/201 X PER OTH- E L EACH ACCIDENT $1,000,000 EL DISEASE- EA EMPLOYEE $1,000,000 EL DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks schedule, may be attached If more space Is required) RE: Event on 07/01/2017 - 0613012018, Senior Nutrition and Programs. City of Gilroy, Its agents, officers and employees are included as Additional Insured (General Liability), per the attached. City of Gilroy Recreation Department 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2014/01) 1 Of 1 #S13174821M1309532 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PAT18 INSURED: YMCA of Silicon valley POLICY #: 5068898919 POLICY PERIOD: 07/01/2017 TO 07/01/2018 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGN_ ATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Gilroy, it's agents, officers and employees 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(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 omis- sions of those acting on your behalf A. In the performance of your ongoing operations, or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0 ISO Properties, Inc , 2004 Page 1 of 1 Client*- 27430 1 / IT, CrL•G]X91 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/29/2017 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(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 Marsh & McLennan Agency LLC �E; Felicia McAroy PHONE 925 482 -9300 a/C No Ext : ac No : 925 482 -9390 Marsh &McLennan Ins Agency LLC E-MAIL SS: Felicia.McAroyOMarshMMA.com 1340 Treat Blvd #250 Lic OH18131 Walnut Creek, CA 94597 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: North River Insurance Company 21105 INSURED YMCA of Silicon Valley 80 Saratoga Avenue Santa Clara, CA 95051 INSURER B: INSURER C : $10,000 INSURER D: INSURER E: $1,000,000 INSURER F: I GENERAL AGGREGATE s3,000,000 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 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 QTR TYPE OF INSURANCE INNSRL WVD POLICY NUMBER MWDDY fY POLICY Y LIMITS A X COMMERCIAL GENERAL LIABILITY 7 CLAIMS MADE OCCUR X 5068898919 D7/01/2017 07/01/2018 $1,000,000 DEAAC�H�OECCCURRENCE PREMISES Eao rrence $1 00O 000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY FI ECOT- F LOC OTHER I GENERAL AGGREGATE s3,000,000 PRODUCTS - COMP /OP AGG $1,000,000 $ AUTOMOBILE LIABILITY 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) $ PROPER -NAMAGE Per axident $ -- _ -- - $ UMBRELLA LIAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- E L EACH ACCIDENT $ EL DISEASE- EA EMPLOYEE $ EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Job Senior Nutrition Program, 7371 Hanna St., Gilroy, CA 95020. City of Gilroy, Its agents, officers and employees are included as Additional Insured (General Liability), per the attached. l�ia:111�1F1_ \la City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2014/01) 1 of 1 #S1310054/M1309682 SHOULD ANY OF THE ABOVE DESCRIBED BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PATR6 INSURED: YMCA of Silicon Valley POLICY #: 5068898919 POLICY PERIOD: 07/01/2017 TO 07/01/2018 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): Where required by written contract 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 — Limiti 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 04 13 © Insurance Services Office, Inc, 2012 Page 1 of 1 feil :.3iWYCRIll YMCAOFSI ACORD. CERTIFICATE OF LIABILITY INSURANCE D7101 /2A,DIYYYT 7/01/2016 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(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 an this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER Barney & Barney, a Marsh .& McLennan Insurance Agency LLC company NAME: Felicia. MCAroy PHONE 925 FAX AIC NO Eel : (AID, 925 462 -9390 Eu Alless: felicia .mcaroy @barneyandbarney.com 1340 Treat Blvd #250 Lic OH18131 Walnut Creek, CA 94597 7/01 12016 NNt tl River Insurance Company INSURER A: River insurance Company � INSURED YMCA of Silicon Valley 80 Saratoga Avenue Santa Clara, CA 95051. INSURER B:. Unit ed.States Fire Insurance CO 121113 INSURER C:. INSURER D: $1,000000 INSURER E: GENERAL AGGREGATE INSURER F: PRODUCTS - COMPIOP AGO S1,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE' FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER .DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE A$DL UB POLICYNUMBER- POLICY EFP POLICY EXP UMW A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 5068856754 7/01 12016 07101/201 EpApCMH�OECCTURRENCE $1,000,000 PREMISES E%=rce Si 000 000 MED EXP ( one person) $10,000 PERSONAL B ADV INJURY $1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ JECT LOG X OTI4ER: GENERAL AGGREGATE 13000000 PRODUCTS - COMPIOP AGO S1,000,000 S _ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS _ 5066856754 0710112016 0710112017 COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Par accident) $ PerOF.EWZDAMAGE $ S IS UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 5821058313 17101120116�07101/2017 EACH OCCURRENCE. $1.000.000 AGGREGATE $1,000,000 DED XI RETENTION $0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY MY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDEDt � (Mandatory inNH) 0 e. daeadtc under DESCRIPTION OF OPERATIONSbelew NIA 406729076 7/0112016 07/01/201 X PER OTH. STATUTE E E.L. EACH ACCIDENT. $1.000.000 E.L. DISEASE - EA EMPLOYEE - $1000000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addldanal Remarks Schedule, mey be attached Jf more spew Is required) RE: Gilroy Senior Center, 7371 Hanna. Street, Gilroy, CA. City of Gilroy is Included as Additional Insured (Gen. Liab.), per the attached. Insurance Is primary and non - contributory. CI of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation Department ACCORDANCE. WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S839200/M838187 PAT12 INSURED: YMCA of silicon valley POLICY #: 6068856764 POLICY PERIOD: 07/01/2016 TO 07/0112017 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): 'Where required by written contract '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 addltonal 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, me 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 04 13 ® Insurance Services Office, Inc., 2012 . Page i of 1 INSURED: YMCA of Silicon Valley POLICY #: 5068856754 POLICY PERIOD: 07/01/2016 TO: 07/01/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 4.a. of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance v✓ill be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary to and noncontributory with any other insurance available to the additional insured. All other terms and conditionsaemain unchanged. FM 101.0.2404 11 08 Page 1 of 1 BARNEY & BARNEY A MARSH & MCLENNAN AGENCY LLC CO 1340 TREAT BLVD STE 250 WALNUT CREEK, CA 94597 -2144 CITY OF GILROY RECREATION DEPARTMENT 7351 ROSANNA ST GILROY CA 95020 -6141