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Home My WebLink AboutCalifornia Youth Outreach - Insurance Certificate (2018)CAYOU -1 OP ID: CM A °a CERTIFICATE OF LIABILITY INSURANCE 1 DA 09 !07! 07/ 0IY2017 097 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 CalNonprofits Insurance Svcs P.Q. Box 640 Capitola, CA.95010 Heidi Jensen CONTACT Heidi Jensen PHONE FAX a/c Na u, : 831 - 427 -5224 Arc N. I: 831- 824 -5068 aI oRess: heidij@cal-insurance.org INSURERS AFFORDING COVERAGE NAIC N INSURER A : NIAC 10023 INSURED CAYouth Outreach aka: Breakout Prison Outreach PO Box 8671 INSURERS: NY Marine & General Ins Co 16608 INSURER C: Travelers 25674 INSURER D: Fresno, CA 93702 INSURER E; 09101/2018 PREMISES Eaoccurrence INSURER F; MED EXP (Any one person) $ 20,000 COVERAGES CERTIFICATE NUMBER: REVISION NIJMRER: 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 MMIDDlYYYY POLICY EXP MMIDDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X 2017 -19976 09/01/2017 09101/2018 PREMISES Eaoccurrence $ 500,000 MED EXP (Any one person) $ 20,000 X I.S.C. $1 M ! AGG $1 M EACH CLAIM PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPlOPAGG $ 3,000,000 X1 POLICY PRO LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea accident)$ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS Per accident BODILY INJURY ( ) $ PROPERTY DAMAGE PER ACCIDENT $ $ UMBRELLA LIAB F OCCUR EACH OCCURRENCE - $ 1,000,000 X AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE 2017 - 19976 -UM13 09/0112017 09/01/2018 OED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' � YIN ANY PROPRIETORIPARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N f A WC201600006947 09/0112017 09/01/2018 A OR X Y O LIM E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS bal I E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Commercial Crime/ 105806482 06/24/2015 06124/2018 Forgery 165,000 Fidelity EE DISHON 165,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Gilroy, its officers and employees are included as Additional Insured as respects Liability arising out of insured's operations per attached automatic Additional Insured Endorsement Form CO2026 04 -13; 30 Days Notice of Cancellation except 10 Days for Non -Pay. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 VAN 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 W 19Hb -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACORbP CERTIFICATE OF LIABILITY INSURANCE DATE 05 /02 /2018 Y) 05/02/2018 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(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 CONTACT Gary Sanchez NAME: ry Gary E Sanchez, a State Farm Agent StateFarm CDI LIC# 0550122 • E MA L E .408- 269 -5001 AX No ADDRESS: gary.sanchez.b89h @statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :State Farm Mutual Automobile Insurance Company 25178 INSURED Breakout Prison Outreach Inc. INSURER B: AMA N PREMISES Ea occurrence)$ California Youth Outreach INSURER C: MED EXP (Any one person) PO Box 8671 INSURER D: Fresno, Ca. 93747 -8671 INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY r_1 PJECT RO ❑ LOC OTHER: INSURER F : $ PRODUCTS - COMP /OP AGG COVERAGES CERTIFICATE NUMBER: 1 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 TYPE OF INSURANCE A DL BR POLICY NUMBER MM DDY/YYYY MM DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1-1 OCCUR 1 EACH OCCURRENCE $ AMA N PREMISES Ea occurrence)$ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY r_1 PJECT RO ❑ LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED ENOL Y 216 6778- D06 -05J 04/0612018 1010612018 COEa MBINED ccident S INGLE LIMIT a $ 1,000,000 BODILY INJURY (Per person) $ 1,000,000 X IAUTOS BODILY INJURY (Per accident) $ 1,000,000 PROPERTY DAMAGE Per accident $ 1,000,000 X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE - EACH OCCURRENCE I AGGREGATE _$ $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) Iryes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Youth counseling services within the City of Gilroy, California CERTIFICATE HOLDER CANCELLATION City of Gilroy, It's Officers, and Employees, as Additional SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insured THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDA WITH THE /PPPLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED EPR IV 88 -2 ORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of RD 1001486 132849.9 02 -04 -2014