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HomeMy WebLinkAboutXavus Solutions - Insurance Certficate (2019)CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 06/26/2018 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 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 CONTACT NAME: _ __— _ — -- - (EAMANo, Ext) (800)_533 -7215 Nog 866 -828 -2424 HUB INTER'L NEW ENGLAND CL CSC _jalc -- ADDRESS: Certlflcate @Hanover.com PO BOX 696 MED EXP (Any one person) A INSURER(S) AFFORDING COVERAGE NAIC# WILMINGTON, MA 01887 _— INSURERA: Massachusetts Bay Ins Co 22306 INSURED XAVUS SOLUTIONS LLC INSURER B: —_- DBA MY SENIOR CENTER INSURER C: INSURER D. ---- PO BOX 55071 .._....._ - - -— - -- - -' POLICY 1 PRO-y I I LOG JECT X INSURER E : BOSTON MA 02205 PRODUCTS- COMP /OPAGG INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NIIMRFR- 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 E AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV BEEN REDUCED BY PAID CLAIMS. INSR LTR I ADDL..SUBR. — - -_. _- _..... -_-- —POLICY EFF I TYPE OF INSURANCE S D'. POLICY NUMBER MMIDD/YYYY POLICY EX P MMlDDIYYYY - — — _. -._ - -- LIMITS AUTHORIZED REPRESENTATIVE 1 X COMMERCIAL GENERAL LIABILITY '.. GILROY, CA 95020 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE I /�� OCCUR DAMAGETO RENTED PREMISES (Eaoccurrence $ 300,000 MED EXP (Any one person) A - Y N ODN914158807 07/01/201807/01 /2019 $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY 1 PRO-y I I LOG JECT X ._..... _.. _. - _ $ 2,000,000 PRODUCTS- COMP /OPAGG $ OTHER: i AUTOMOBILE 1 SINGLE LIMIT LEa accident) $ 1,000,000 [COMBINED BODILY INJURY (Per person) — - $ ANY AUTO � A ' OWNED ' scHEDULED Y - N ODN 9141588 07 AUTOS ONLY AUTOS HIRED NON -OWNED ! X AUTOS ONLY X AUTOS ONLY - 07/01/2018; 07/01/2019 BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident $ _ _ $ UMBRELLA LIAR _ i OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE I AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION I EMPLOYERS LIABILITY IANYPROPRIETOR IPARTRIERlEXECUTIVE YIN I OFFICERIMEMSER EXCLUDED? ❑ NIA _ PER 5 TH- !STATUTE ER EL. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE — $ (Mandatory in NH) It yes, describe under - -- - - - -__- - E -L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below Is DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Isrequired) City of Gilroy, its officers, officials and employees are Additional Insured on the General Liability pursuant to the terms and conditions by form 391 -1941. CERTIFICATE HOLDER CANCFI I ATION ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF GILROY ACCORDANCE WITH THE POLICY PROVISIONS. ITS OFFICERS, OFFICIALS AND EMPLOYEES AUTHORIZED REPRESENTATIVE 7351 ROSANNA STREET GILROY, CA 95020 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CDN 9141588 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Person or Organization: City of Gilroy, its officers, officials and employees (If no entryappears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION II — LIABILITY: A. The following is added to SECTION II — LIABILITY, C. Who is an Insured: Any person or organization shown in the Schedule above is also an additional insured, 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 in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. b. The insurance afforded to such additional insured only applies to the extent permitted by law; and 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. The following is added to SECTION II — LIABILITY, 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: a. Required by the contract or agreement; or b. 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. ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. 391 -1941 08 16 Includes copyrighted material of Insurance Services Offices, Inc., with its peirnission. Page 1 of 1