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Home My WebLink AboutStick & Move Amateur Boxing Club - Insurance Certificate (2019)STICAMA -01 AMANDA CERTIFICATE OF LIABILITY INSURANCE 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 DATE 08 /03 /2018 Y) 08/03/2018 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 License # OK07568 Pacific Diversified Insurance Services 15005 Concord Circle, Suite 110 408 - 842 -2131 CONTACT Amanda Link, CISR, CLCS NAME: _ PHONE FAX (A/c, No, Ext): (A/C, No): E-MAIL alink @pdins.com Morgan Hill, CA 95037 INSURERS AFFORDING COVERAGE NAIC # wsuRERA:Penn -Star Insurance Co CPV0021659 08/31/2018 INSURED INSURER B: $ 1,000,000 INSURERC: $ 100,000 Stick -N -Move Amatuer Boxing Club INSURER D: 7400 Railroad Street Gilroy, CA 95020 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MMID LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR X CPV0021659 08/31/2018 08/31/2019 EACH OCCURRENCE $ 1,000,000 DAMASETO(Eaoccurence PREM $ 100,000 MED EXP (Any one person 5 000 $ � PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY r JECT C —! LOC GENERAL AGGREGATE $ 2,000,000 I PROD S - COMP /OP AG G $ Included $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person) i $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PerraccidenDAMAGE AUTOS ONLY AUUTOS ONLY UMBRELLALIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ $ EXCESS LIAB AGGREGATE DED I RETENTION $ _ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE _ E E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mand lo;y :n NH) If yes, describe under NIA I E.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rerrarks Schedule, may be attached N more space is required) Re: 7400 Railroad St., Gilroy, CA 95020 City of Gilroy, its officers, officials, and employees are hereby named as additional insureds in regards to the General Liability Policy where required by written contract. City of Gilroy 7351 Rosanna Street 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 REPRESENTATIVE V W ACORD 25 (2016/03) @ 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD