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HomeMy WebLinkAboutSanta Clara County Library - Insurance Certificate (2019)� a DATE (MM/DD/YYYY) ACCCERTIFICATE OF LIABILITY INSURANCE 10/26/18 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 UUN I AU 1 Alliant Insurance Services, Inc. PHONE FAX 1301 Dove Street, Suite 200 (A/C, No, Est): (A/C. No): E-MAIL Newport Beach, CA 92660 ADDRESS: INSURED SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD 1370 DELL AVENUE CAMPBELL, CA 95008 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: GREAT AMERICAN E&S INSURANCE COMPANY 37532 INSURER B : INSURER C : INSURER D : INSURER E : INSURERF: 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 ADDLSUBR POLICYEFF I POLICYEXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X X 2145100 01 09/29/18 09/29/19 EACH OCCURRENCE CLAIMS -MADE X❑ OCCUR GL DED: $1,000 DED GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAR HCLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANYPROPRIETOR/PARTNER/EXECU I IVE ❑ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO RENTED $10.000.000 PREMISES (Ea occurrence) $1.000.000 MED EXP (Any one person) N/A PERSONAL &ADV INJURY $10.000.000 GENERAL AGGREGATE N/A* PRODUCTS - COMP/OP AGG $10.000.000 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE $ AGGREGATE $ $ PE STATUTE I I ERH 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) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED AT 350 WEST SIXTH STREET, GILROY, CA. CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONAL INSURED. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: A CORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY 1 NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: Alliant Insurance Services, Inc. j SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY POLICY NUMBER i BOARD 2145100 01 1370 DELL AVENUE CARRIER NAIC CODE CAMPBELL, CA 95008 GREAT AMERICAN E&S INSURANCE COMPANY 37532 EFFECTIVE DATE: 09/29/18 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2016103) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON-PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Personal Injury" (including `Bodily Injury") and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. GL330138 0916 Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Primary and Non -Contributory Coverage Endorsement This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON-PROFIT CORPORATIONS The following is added to Section VUL COMMON POLICY CONDITIONS: If insurance similar to this insurance is held by a person or organization that is an additional insured on this policy, this insurance is primary to that other insurance. The "Company" shall not seek contribution from that other insurance for amounts payable under this insurance for liability arising out of the "Participating Named Insured's" ongoing operations performed for that person or organization under written agreement. However, the provisions of this endorsement do not apply to a person or organization unless the "Participating Named Insured" had a written agreement with that person or organization requiring: a. This insurance be primary insurance; b. They be an additional insured on this Policy; and C. The written agreement was entered into prior -to the date the "Participating Named Insured's" operations for that person or organization commenced. GL330152 0911 Includes copyrighted material of ISO, Inc., used with permission Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUBROGATION This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON- PROFIT CORPORATIONS The following is added to Section VIII. COMMON POLICY CONDITIONS: (D) Subrogation. To the extent of any payment hereunder, the "Company" shall be subrogated to all of the "Insured's" rights of recovery, therefore; and the "Insured" shall do nothing after loss to prejudice such rights and shall do everything necessary to secure such rights. Any amount so recovered shall be apportioned as follows: Any interest, including the "Insured's", having paid an amount in excess of any "Participating Named Insured's" Self- Insured Retention plus the Limit of Liability hereunder shall be reimbursed first to the extent of actual payment. The "Company" shall be reimbursed next to the extent of its actual payment hereunder. If any balance then remains unpaid, it shall be applied to reimburse the "Participating Named Insured". The expenses of all such recovery proceedings shall be apportioned in the ratio of the respective recoveries. If there is no recovery in proceedings conducted solely by the "Insured', it shall bear the expenses thereof. However, the "Company" will waive its right of subrogation against any person or organization for whom the "insured' is performing operations, but only if: 1) That person or organization requires in the written agreement with the "Participating Named Insured" that the "Participating Named Insured" waive its right of recovery against that person or organization; and 2) The written agreement is made prior to the date of the "Occurrence". Includes copyrighted material of ISO Properties, Inc., 2004 with its permission Page 1 of 1 GL330299 0916 Page 1 of 1 Ed 0916 DATE (MMIDD/YYY10 ''� CERTIFICATE OF LIABILITY INSURANCE I 04/29/19 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 CUNIAC1 NAME: Alliant Insurance Services, Inc. PHONE I FAX 1301 Dove Street, Suite 200 I EAIM INo, Ext): (A/c. Nor Newport Beach, CA 92660 i ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD 1370 DELL AVENUE CAMPBELL, CA 95008 INSURERA: GREAT AMERICAN E&S INSURANCE COMPANY 37532 INSURER B : INSURER C : INSURER D : INSURER E : INSURERF: 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. ILTR TYPE OF INSURANCE AINSD SUBR WVD POLICY NUMBER (MN DDNYI l) (MWDD YYYY) I LIMITS A X COMMERCIAL GENERAL LIABILITY X 2145100 01 09/29/18 09/29/19 1 EACH OCCURRENCE S1 _CLAIMS -MADE X❑ OCCUR GL DED: $1,000 DED GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO JECT ❑ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY - AUTOS HIRED NON -OWNED AUTOS ONLY - AUTOS ONLY UMBRELLA LU\B OCCUR EXCESS LIAB HCLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below DAMAGE TO RENTED n "n0.000 PREMISES (Ea occurrence) S1.000.000 MED EXP (Any one person) N/A PERSONAL & ADV INJURY S10.00Q Q00 GENERALAGGREGATE N/A* PRODUCTS - COMP/OP AGG $10-OOMOO COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) I EACH OCCURRENCE $ (AGGREGATE $ STATUTE EORH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) *POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS USE OF PREMISES FOR THE GILROY MINI MAKER FAIRE BEING HELD JULY 13, 2019. CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: ACORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: Alliant Insurance Services, Inc. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY POLICY NUMBER BOARD 2145100 01 1370 DELL AVENUE CARRIER NAIC CODE I CAMPBELL, CA 95008 GREAT AMERICAN E&S INSURANCE COMPANY 137532 I EFFECTIVE DATE: 09/29/18 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2016/03) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON-PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Personal Injury" (including "Bodily Injury") and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. GL330138 0916 Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission