Loading...
HomeMy WebLinkAboutSouth Santa Clara County Fire District - Insurance Certificate (2019)AC oR" CERTIFICATE OF LIABILITY INSURANCE DATE E /29/z018YY) 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 Arthur J. Gallagher & Co. Insurance Brokers of CA. Inc., License #0726293 1255 Battery Street #450 CON ACT NAME: PHONE FAX A C No Ext : 415- 546 9300 A C No :415- 536 -8499 A DRIESS: San Francisco CA 94111 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Allied World Assurance Company Ltd EACH OCCURRENCE $1,000,000 INSURED FIREAGE -01 South Santa Clara County FPD 15670 Monterey Street INSURER B: $1,000,000 INSURER C MED EXP (Any one person) INSURER D: Morgan Hill, CA 95037 INSURER E: $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F PRO- LOC JECT OTHER: INSURER F : $ 10,000,000 PRODUCTS - COMP /OP AGG COVERAGES CERTIFICATE NUMBER: 1525230119 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 SUBR POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR 0 SIR Y JPAPKGO02370OF 7/1/2018 7/1/2019 EACH OCCURRENCE $1,000,000 PREMISES D PREMISES Ea occurrence ) $1,000,000 X MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F PRO- LOC JECT OTHER: GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP /OP AGG $10,000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINEDSINGLELIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acciden t $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR /PARTNER /EXECUTIVE I OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/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 Remarks Schedule, may be attached If more space Is required) City of Gilroy, its Officers, Officials and Employees are also named as Additional Insureds as respects the shared of Battalion Chief Agreement. l�L?IGfll7l�fa a�� �Lq: rL1C1p139 +_U Lei 0 City of Gilroy 7351 Rosanna Street Gilroy CA 95020 USA 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 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:JPAPKG0023700F ADDITIONAL INSURED - AUTOMATIC THIS ENDORSEMENT CHANGES THE COVERAGE FORM. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION II. — WHO IS AN INSURED is amended to include as an insured any person or organization but only with respect to the following: A. 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 premises owned by or rented to you; B. Liability arising out of the ownership, maintenance or use of premises leased to you and subject to the following additional exclusions: 1. any "occurrence" which takes place after you cease to be a tenant at that premises. 2. structural alterations, new construction or demolition operations performed by or on behalf of the person or organization you have leased from. FR -GL 00006 00 (05/15) Page 1 of 1 Includes copyrighted material of Insurance Services Offices, Inc. with its permission.