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HomeMy WebLinkAboutSenior Center Craft Shop - Insurance Certificate (2019)ACORDF CERTIFICATE OF LIABILITY INSURANCE �-' DATE(MM/DD /YYYY) 103/15/2018 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 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). PRODUCER PCB Insurance Services, LLC NAME: Angie Phillips _PHO" o. ExO408- 847 -1000 FAX No :408- 848 -2314 P.O. 1749 Gilroy, CA 95021 ADDRESS: angieApacbenins.corn INSURERS AFFORDING COVERAGE NAIC a INSURER A Liberty Mutual Insurance BZS 58664301 04/02/2018 INSURED Gilroy Senior Craft Store 7371 Hanna Street Gilroy, CA 95020 INSURER B : S1,000,000 .. ......- ......._.._............. $1,000,000 INSURER C': MED EXP (Any one person ) INSURER 0: 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 SUER POLICY NUMBER POLICY EFF IMMIDDIYYYYI POLICY EXP. IMM/DDlYYYY1 LIMITS A x COMMERCIAL GENERAL LIABILITY ..... �;- ; CLAIMS-MADE � OCCUR BZS 58664301 04/02/2018 oa/o2nol s EACH OCCURRENCE ��OAAAAGE�TO RENTED' ........................................_ PREMISES (Ea occurrence S1,000,000 .. ......- ......._.._............. $1,000,000 MED EXP (Any one person ) $15,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. X POLICY FI JECT LOC GENERAL AGGREGATE 52,000,000 PRODUCTS - COMP/OP AGG 52,000,000 S OTHER: A AUTOMOBILE LIABILITY = BZS 58664301 0410212018 04/02/2019 COMBINED SINGLE LIMIT ..IEa_acc/ dent)..._ ... .......................... ..._- $1 ,000,000 ANY AUTO BODILY INJURY Per ( person) S X OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additlonal.Remarke Schedule, may be attached It more space Is required) Certificate holder is named as Additional Insured as respects to liability. lotK I IrIUA I It MULUtK CANCELLATION City of Gilroy, its agents, officer and employees 7351 Rosanna St 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 REPI39SENTATIVE4- ARP ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ARP on April 17, 2018 at 01:34PM ACORO® CERTIFICATE OF LIABILITY INSURANCE llko.� I DATE `"I°"�°°"'"�' 103/15/2018 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 pol"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). PRODUCER PCB Insurance Services, LLC CONT. CT Angie Phillips PHONE 408 -847 -1000 I FAX No ;408 -848 -2314 P.O. 1749 Gilroy, CA 95021 0 "'E annieAwacbenins.com INSURE R(111) AFFORDING COVERAGE NAIC 0 INSURER A Libe Mutual Insurance X - X INSURED Gilroy .Senior Craft Store 7371 Hanna Street Gilroy, CA. 95020 INSURER B INSURER C ()4/0212018 INSURER D: EACH OCCURRENCE _ RE ISESocw�nce INSURER E: INSURER F: 515,000 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 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 SUBA POLICY NUMBER Y EFF POLICY EX LIMITS A X - X COMMERCIALS �y-� CLAIMS -MADE F_k1 OCCUR BZS 58.664301 ()4/0212018 04/0212019 EACH OCCURRENCE _ RE ISESocw�nce $11,000,000 _._..._....... $1,000,000 MED EXP one person) 515,000 PERSONAL a AOV INJURY $1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: X POLICY PRO- JECT F-1 LOC GENERAL AGGREGATE 52,000,000 PRODUCTS - COMP/OP AGO s2,000,000 $ OTHER:. AUTOMOBB.E LIABILITY COMB SINGLE LIMIT — _.—ntl $ - - - - - -- -- - -- _ ANY AUTO BODILY INJURY (Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NO"WNED . AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE r accident $ 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA PER OTH- STATUTE ER E.L. EACH ACCIDENT 5 E.L. DISEASE - EA EMPLOYEE s (Mandatory In NH) It yes des0be udder E.L DISEASE - POUCY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addrdo, I Remarlra Schedule, may be attached H more apace Is required) Certificate holder is named as Additional Insured as. respects to liability. City of Gilroy, its agents, officer and employees 7351 Rosanna St Gilroy, CA 95020 CLILA 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 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by ARP on March 29, 2018 at 11:49AM s c N � s POLICY NUMBER: BUSINESSOWNERS BP 04 02 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Designation Of Premises (Part Leased To You): 7371 Hanna St Gilroy CA Name Of Person(s) Or Organization(s) (Additional Insured): City of Gilroy its agents, officers and employees 7351 Rosanna Street GILROY, CA 95020 Additional Premium: $ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Liability is amended as follows: A. The following is added to Paragraph C. Who Is An Insured: 3. The person(s) or organization(s) shown in the Schedule is also an additional in- sured, but only with respect to liability arising out of the ownership, mainten- ance or use of that part of the premises leased. to you and shown in the Schedule. However: a. The insurance afforded to such add!- tional insured only applies to the ex- tent permitted by law; and b. If coverage provided to the addition- al insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are re- quired by the contract or agreement to provide for such additional in- sured. B. With respect to the insurance afforded to these additional insureds the following addi- tional exclusions apply: This insurance does not apply to: BP 04 02 07 13 1. Any "occurrence" that takes place after you cease to , be a tenant in the premises described in the Schedule. 2. Structural alterations, new construction or demolition operations performed by or for the person(s) or organization(s) des- ignated in the Schedule.. C. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability And Medical Expenses 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 ap- plicable Limits Of Insurance shown in the Declarations. © Insurance Services Office, Inc., 2012 Page 1 of 1