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HomeMy WebLinkAboutCommunity Solutions - Insurance Certificate (2019)M PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA,,SUITE 100 BALA CYNWYD PA 19004 REINSTATEMENT NOTICE Named Insured & Mailing Address: COMMUNITY SOLUTIONS FOR CHILDREN, 9015 MURRAY AVE STE 100 GILROY CA 95020-3617 Producer: 0013902 ACRISURE OF CALIFORNIA, LLC DBA SUHR 910 E HAMILTON AVE STE 410 CAMPBELL CA 95008-6438 Policy No.: PHPK1874749 = Type of Policy: 'PACKAGE You recently received a notice advising this policy was being cancelled effective 05/20/2019 . _ This notice is to advise that the policy is being reinstated Without lapse in coverage. I I I I HIM Other Party of Interest CITY OF GILROY, ITS OFFICERS, 7351 ROSANNA ST GILROY CA 95020-6141 FORM# CT969897CA51995 CIDEN 3.0.19.02a nnn737n—nno2622 Date Mailed: 30th day of April, 2019 MISSY LYNCH CACT19 04292019S N NY Copy for Other Interests Page 1 of 1 Ir- PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA, SUITE 100 BALA CYNWYD PA 19004 NOTICE OF CANCELLATION OF INSURANCE Named Insured & Mailing Address: COMMUNITY SOLUTIONS FOR CHILDREN, 9015 MURRAY AVE STE 100 G I LROY CA 95020-3617 Producer: 0013902 ACRISURE OF CALIFORNIA, LLC DBA SUHR 910 E HAMILTON AVE STE 410 CAMPBELL CA 95008-6438 Policy No.: PHPK1874749 Type of Policy: PACKAGE Date of Cancellation: 05/20/2019; 12:01 A.M. Local Time at the mailing address of the Named Insured. We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above. The reason for cancellation is NONPAYMENT OF PREMIUM 4854.14. This policy provides fire and extended coverage insurance on your property. You should contact your agent concerning coverage through another insurer, or your eligibility for coverage through the California Fair Plan, P.O. Box 76924, Los Angeles, CA 90076, Phone: (800) 339-4099 or www.cfpnet.com. Your interest in this policy as an "insured" or other party of interest is being cancelled effective 05/20/2019; 12-.'01 A.M. Local Time at the mailing address of the named insured. Other Party of Interest CITY OF GILROY, ITS OFFICERS, 7351 ROSANNA ST G I LROY CA 95020-6141 Date Mailed: 2 9th day of April; 2019 MISSY LYNCH 11 1 1 111 111 1 1 11 1 1 1 111 FORM# CC969701 CA1 12017 ODEN 3.0.19.02a Copy for Other Interests 0001124-0002275 CACC19NONPMNT 04282019MYNY Pagel of 1 PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA, SUITE 100 BALA CYNWYD PA 19004 NOTICE OF CANCELLATION OF INSURANCE Named Insured & Mailing Address: COMMUNITY SOLUTIONS FOR CHILDREN, 9015 MURRAY AVE STE 100 GILROY CA 95020-3617 Producer: 00 13902 ACRISURE OF CALIFORNIA, LLC DBASUHR 910 E HAMILTON AVE STE 410 CAMPBELL CA 95008-6438 Policy No.: PHPK1874749 Type of Policy: PACKAGE Date of Cancellation: 02/18/2019-1 12:01 A.M. Eastern Time at the mailing address of the Named Insured. We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above. The reason for cancellation is NONPAYMENT OF PREMIUM 4580.23. This policy provides fire and extended coverage insurance on your property. You should contact your agent concerning coverage through another insurer, or your eligibility for coverage through the California Fair Plan, P.O. Box 76924, Los Angeles, CA 90076, Phone: (800) 339-4099 or www.cfpnet.com. Your interest in this policy as an "insured" or other party of interest is being cancelled effective 02/18/2019; 12:01 A.M. Eastern Time at the mailing address of the named insured. Additional Insured • •ti s CITY OF GILROY, ITS OFFICERS, 7351 ROSANNA ST GILROY CA 95020-6141 Date Mailed: 28th day of January, 2019 MISSY LYNCH FORM# CC969701CAI 12017 ODEN 3.0.18.12a 0000616-1100 L;5� Copy for Additional Insured CACC19NONPMNT 01282019MYNY Page 1 of 1 PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA, SUITE 100 BALA CYNWYD PA 19004 NOTICE OF CANCELLATION OF INSURANCE Named Insured & Mailing Address: COMMUNITY SOLUTIONS FOR CHILDREN, 9015 MURRAY AVE STE 100 GILROY CA 95020-3617 Producer: 0013902 ACRISURE OF CALIFORNIA, LLC DBA SUHR 5300 STEVENS CREEK BLVD STE 300 SAN JOSE CA 95129-1037 Policy No.: PHPK1874749 Type of Policy: PACKAGE Date of Cancellation: 01/23/2019; 12:01 A.M. Eastern Time at the mailing address of the Named Insured. We are cancelling this policy. Your insurance will cease on the Date of Cancellation shown above. The reason for cancellation is NONPAYMENT OF PREMIUM 9770.65. This policy provides fire and extended coverage insurance on your property. You should contact your agent concerning coverage through another insurer, or your eligibility for coverage through the California Fair Plan, P.O. Box 76924, Los Angeles, CA 90076, Phone: (800) 339-4099 or www.cfpnet.com. Your interest in this policy as an "insured" or other party of interest is being cancelled effective 01/23/2019; 12:01 A.M. Eastern Time at the mailing address of the named insured. Additional Insured CITY OF GILROY, ITS OFFICERS, 7351 ROSANNA ST GILROY CA 95020-6141 Date Mailed: 2nd day of January, 2019 A -0 - 10 MISSY LYNCH CACC19NONPMNT FORM4 CC969701CA112017 01012019MYNY ODEN 3.0.18-12a Copy for Additional Insured Page 1 of 1 COMMUO1 u� iu: JV IE ?RI CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 09/04/2018 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 Suhr Risk Services 5300 Stevens Creek Blvd. San Jose, CA 95129 Jeff State, CRIS, CWCS CONTACT PHONE I FAX (A/C, No, Eat): (A/C, No): E -MAIL ADDRESS; INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Philadelphia Indemnity Ins. COMMERCIAL GENERAL LIABILITY 18058 10855 INSURED Community Solutions for Children, Families and Individuals 9015 Murray Avenue #100 Gilroy, CA 95020 INSURER B : Cypress Insurance Company (CA) INSURER C : Fidelity & Deposit Company 39306 INSURER D : $ 1,000,000 INSURER E : i CLAIMS -MADE INSURER F : OCCUR COVERAGES CERTIFICATE 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 IMM /DD/YYYY1 POLICY EXP IMM /DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK1874749 PHPK1874749 09/01/2018 09/01/2018 09/01/2019 09/01/2019 EACH OCCURRENCE $ 1,000,000 i CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 1,000,000* $ X ProfLiabiltity MEDEXP(Anyoneperson) $ 20,000* PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES POLICY r-1 PRO- JECT OTHER PER LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS $ 3,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY PHPK1874749 09/01/2018 09/01/2019 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB645632 09/01/2018 09/01/2019 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? J (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS betou, N / A COWC926612 07/01/2018 07/01/2019 PER STATUTE 0TH - ER E - EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E L. DISEASE - POLICY LIMIT $ - ,000,000 A C Crime Crime Excess PHPK1874749 CCP006841604 09/01/2018 07/01/2018 09/01/2019 07/01/2019 Per Occ Per Occ 500,000 4,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Proof of Coverage City of Gilroy, its Officers, Representatives, Agents and Employees are named as additional insured per attached endorsement form CERTIFICATE HOLDER CANCELLATION CITYGIL City of Gilroy Community Development Dept. Attn: Sandra Cruz 7351 Rosanna Street Gilroy, CA 95020 -6197 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 4144 ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy:PHPK1874749 PI- GLD -HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non -Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments — Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments — Bail Bonds $5,000 5 Supplementary Payment — Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement — Janitorial Services Client Coverage $10,000 limit 6 Additional Insured — Newly Acquired Time Period Amended 6 Additional Insured — Medical Directors and Administrators Included 7 Additional Insured — Managers and Supervisors (with Fellow Employee Coverage) Included 7 Additional Insured — Broadened Named Insured Included 7 Additional Insured — Funding Source Included 7 Additional Insured — Home Care Providers Included 7 Additional Insured — Managers, Landlords, or Lessors of Premises Included 7 Additional Insured — Lessor of Leased Equipment Included 7 Additional Insured — Grantor of Permits Included 8 Additional Insured — Vendor Included 8 Additional Insured — Franchisor Included 9 Additional Insured — When Required by Contract Included 9 Additional Insured — Owners, Lessees, or Contractors Included 9 Additional Insured — State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company PI- GLD -HS (10/11) Duties in the Event of Occurrence, Claim or Suit Included 10 Unintentional Failure to Disclose Hazards Included 10 Transfer of Rights of Recovery Against Others To Us Clarification 10 Liberalization Included 11 Bodily Injury — includes Mental Anguish Included 11 Personal and Advertising Injury — includes Abuse of Process, Discrimination Included 11 A. Extended Property Damage SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph a. is deleted in its entirety and replaced by the following: a. Expected or Intended Injury "Bodily injury" or property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. B. Limited Rental Lease Agreement Contractual Liability SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph b. Contractual Liability is amended to include the following: (3) Based on the named insured's request at the time of claim, we agree to indemnify the named insured for their liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of their client, up to $50,000. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the client. C. Non -Owned Watercraft SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Subsection 2. Exclusions, Paragraph g. (2) is deleted in its entirety and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess or contingent. D. Damage to Property You Own, Rent or Occupy SECTION I — COVERAGES, COVERAGE A BODILY INJURY AND PROPERTY DAMAGE Page 2 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company