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HomeMy WebLinkAboutSourcewise (Senior Adults Legal Assistance) - Insurance Certificate (2020)CERTIFICATE OF LIABILITY INSURANCE DATE(M06/13/2D/YYYY) /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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER I CONTACT Philman Kim NAME: ISU/San Francisco I PH NN E. Extl: (415) 788-9810 I FAX No): (415) 248-3534 CAJ201 California St., Suite 200 I E-MAIL pkim@isusf.com ADDRESS: License # 0778092 I INSURER(S) AFFORDING COVERAGE NAIC # San Francisco CA 94111-5098 INSURER A: Nonprofits Ins Alliance of CA INSURED INSURER B : MARKEL FIRSTCOMP 0131 Senior Adults Legal Assistance, DBA: SALA I INSURER C : 1425 Koll Circle #109 I INSURER D : INSURER E : San Jose CA 95112 I INSURER F : COVERAGES CERTIFICATE NUMBER: 19-20 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 CONTRACTOR 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 AUDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 v CLAIMS -MADE /NOCCUR DAMAGE TO RENTED I PREMISES (Ea occurrence) 500,000 $ _ I MED EXP (Any one person) $ 20,000 A Y 201904545NPO 06/30/2019 06/30/2020 I PERSONAL & ADV INJURY $ Excluded GEN'LAGGREGATE LIMITAPPLIES PER: I GENERAL AGGREGATE $ 2,000,000 i< PRO I 2,000,000 POLICY JECT LOC PRODUCTS -COMP/OP AGG $ OTHER: Liquor Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANYAUTO I BODILY INJURY (Per person) $ A OWNED SCHEDULED 201904545NPO 06/30/2019 06/30/2020 I BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON -OWNED PROPERTY DAMAGE I $ _ AUTOS ONLY _ AUTOS ONLY (Per accident) x UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ 2,0005000 A EXCESS LIAR 201904545UMB 06/30/2019 06/30/2020 I AGGREGATE $ 2,0005000 DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN XI STER ATUTE I I EORH I 1,000,000 B OFFICER/MEMBER EXCLUDED? ❑ N/A MWC006622506 07/01/2019 07/01/2020 E.L. EACH ACCIDENT $ (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ Each Claim $1,0005000 Improper Sexual Conduct A and Phsical Abuse 201904545NPO 06/30/2019 06/30/2020 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its agents, officers and employees are included as Additional Insured as respects to Liability as required by written contract only as pertains to the Insured's operations as per Form CG 2026. 30 day written notice except 10 days for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy Department of Parks and Recreation ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 �.•�� I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2019-04545 Named Insured: Senior Adults Legal Assistance dba: SALA COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): City of Gilroy, its agents, officers and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to 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 your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. nth respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1