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HomeMy WebLinkAboutGilroy Gardens - Insurance Certificate (2020)-ACC_>RV CERTIFICATE OF LIABILITY INSURANCE I DATE (M M/D D/YYYY) 03/29/2019 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAC'i EVENTS & ATTRACTIONS NAME: K&K INSURANCE GROUP, INC. (C, FAX Ext): 800-553-8368 / No): 260-459-5624 P.O. BOX 2338 E-MAIL FORTWAYNE IN 46801 ADDRESS: INSURER(S) AFFORDING COVURAGE NAIC # INSURER A: SCOTTSDALE INDEMNITY COMPANY_ 15580 INSURED INSURER B: NATIONAL CASUALTY COMPANY 11991 GILROY GARDENS FAMILY THEME PARK INSURER C: 3050 HECKER PASS HIGHWAY GILROY, CA 95020 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C100310 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 CONDITION OF SUCH POLICIES. LIMITS SF OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSIR TYPE OF INSURANCE DDL ANSD SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y KKI0000022990000 3/30/2019 3/30/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR 12:01 AM 12:01 AM DAMAGE TO RENTED PREMISES (Ea Occurrence) $300,000 X LIQUOR LIMITS - $1,000,000/$1,000,000 AGG MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE UNLIMITED GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $5,000,000 POLICY C-� PROJECT LOC LEGAL LIAB TO PARTICIPANTS NC OTHER: PROFESSIONAL LIABILITY A AUTOMOBILE LIABILITY KKI0000022990100 3/30/2019 3/30/2020- COMBINED SINGLE. LIMIT (Ea accident) $1,000,000 X ANY ALTO 12:01 AM 12;01 AM . I BODILY INJURY (Per person) OWNED SCHEDULED AUTOS AUTOS ONLY BODILY INJURY (Per accident) - HIRED NON -OWNED X PROPERTY DAMAGE AUTOS ONLY _X AUTOS ONLY (Per accident) B UMBRELLA LIAB X OCCUR XK00000022990200 3/30/2019 3/30/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS -MADE 12:01 AM 12:01 AM � AGGREGATE $4,000,000 _ _ DED F1 RETENTION B AND�KERS EMPLOY EMPLOYERS' LIABILITY COMPENSATION NIA WCC331226A 3/30/2019 3/30/2020 STATUTE LJ OTHER ANY PROPRIETOR/PARTNER/ 12:01 AM 12:01 AM EXE"CUTIVE OFFICER/MI5MBFR Y / N _ _. _. "_ E.l_ EACFI ACCIDENT $1,000,000 EXCLUDED? (Mandatory in NH)"" If yes, describeunder I J -"— E.L. DISEASE -EA EMPLOYEE $1,000,000 DES(RIP ON 01"- OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schodule, may be attached if more space is required) SEE ATTACHED ADDENDUM CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 7351 ROSANNA STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH GILROY, CA 95020 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2015103) Cc) 19u:h201a ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: q� CERTIFICATE: C100310 DATE ISSUED: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED K&K INSURANCE GROUP, INC. GILROY GARDENS FAMILY THEME PARK P.O. BOX 2338 3050 HECKER PASS HIGHWAYGILROY, CA 95020 FORT WAYNE, IN 46801 POLICY NUMBER SEE ACORD 25 CARRIER EFFECTIVE DATE l SEE ACORD 25 SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACOrd25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CITY OF GILROY, ITS OFFICERS, OFFICALS, AND EMPLOYEES ARE ADDED AS ADDITIONAL INSURED, BUT ONLY FOR LIABILITY CAUSED, IN WHOLE OR IN PART, BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved, The ACORD name and Kano are registered marks of ACORD AC 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/Db1YYYY; 03/29/2019 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT EVENTS & ATTRACTIONS NAME: K&K INSURANCE GROUP; INC. PHONE A//C, No, Ext): 800-553-8368 (A/c NO: 260=459-5624 P.O., BOX 2338 E-MAIL - - - FORT WAYNE, IN 46801 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # " INSURER A: SCOTTSDALE INDEMNITY COMPANY--,15580' INSURED INSURER B: NATIONAL CASUALTY COMPANY 11991 GILROY GARDENS FAMILY THEME PARK INSURER C: 3050 HECKER PASS HIGHWAY INSURER D: GILROY, CA 95020 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C100310 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 TYPE OF INSURANCE ADDL ' SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y KKI0000022990000 3/30/2019 3/30/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE a OCCUR 12:01 AM 12:01 AM DAMAGE TO RENTED 300,000 PREMISES (Ea Occurrence) $ X LIQUOR LIMITS - MED EXP (Any one person) EXCLUDED $1,000,000/$1,000,000 AGG PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE UNLIMITED GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS —COMP/OP AGG $5,000"000 X POLICY C�J PROJECT ❑ LOC LEGAL LIAB TO PARTICIPANTS NC OTHER: PROFESSIONAL LIABILITY A AUTOMOBILE LIABILITY KKI0000022990100 3/30/2019 3/30/2020 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO 12:01 AM. 12:01 AM . BODILY INJURY (Per person) OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) AUTOS ONLY HIRED NON -OWNED X X PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) B UMBRELLA LIAB X OCCUR XK00000022990200 3/30/2019 3/30/2020 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS -MADE 12:01 AM 12:01 AM AGGREGATE $4,000,000 DED n RETENTION B WO 2KERS COMPENSATION N/A LIABILITY WCC331226A 3/30/2019 3/30/2020 X SPER TATUTE OTHER AND EMPLOYERS' ANY PROPRIETOR/PARTNER/ Y/ N 12:01 AM 12:01 AM u E.L. EACH ACCIDENT $1,000,000 EM( ,UTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) I If describe under LJ _._ E.L. DISEASE — EA EMPLOYEE $1,000,000 yes, DESCRIPTION OF OPERA I IONS below E.L. DISEASE—PULICYLIMIT $1,000,000 PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED ADDENDUM CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 7351 ROSANNA STREET EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH GILROY, CA 95020 THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (201fr03) ©'19r 3 201r ACORD CORPORAT!01114. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC #: AC'" 1 ® CERTIFICATE: C100310 DATE ISSUED: --�--v" ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED K&K INSURANCE GROUP, INC. GILROY GARDENS FAMILY THEME PARK P.O. BOX 2338 3050 HECKER PASS HIGHWAYGILROY, CA 95020 FORT WAYNE, IN 46801 POLICY NUMBER SEE ACORD 25 CARRIER EFFECTIVE DATE SEE ACORD 25 SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acorc125 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CITY OF GILROY, ITS OFFICERS. OFFICALS, AND EMPLOYEES ARE ADDED AS ADDITIONAL INSURED, BUT ONLY FOR LIABILITY CAUSED, IN WHOLE OR IN PART, BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and Inge are registered marks of ACORD _ _