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HomeMy WebLinkAboutYMCA of Silicon Valley - Insurance Certificate (2020)Client#: 443977 YMCASILIC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/02/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McAroy Marsh & McLennan Agency LLC PHONE 925 482-9300 FAX 92 CA/C, No, E,* (A/C, No): 5 482-9390 Marsh & McLennan Ins Agency LLC E-MAIL ADDREss: Felicia.McAroy@MarshMMA.com 1340 Treat Blvd #250 INSURER(S) AFFORDING COVERAGE NAIC # Walnut Creek, CA 94597 INSURER A : United States Fire Insurance Company 21113 INSURED INSURER B : Berkshire Hathaway Homestate Ins Co 20044 YMCA of Silicon Valley 80 Saratoga Avenue INSURER C : Santa Clara, CA 95051 INSURER D 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 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, LTR TYPE OF INSURANCE ADDLSUBRPOLICY EFF POLICY EXP NSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X 5068968543 07/01/2019 07/01/202 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ® OCCUR PREMISES (Ea RENTED $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY JECOT ❑ LOC I PRODUCTS - COMP/OP AGG $1,000,000 OTHER: $ A AUTOMOBILE LIABILITY 5068968543 07/01/2019 07/01/202 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO I BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY A X UMBRELLA LIAB X OCCUR 5821124616 EXCESS LIAB CLAIMS -MADE DIED I X RETENTION $O B WORKERS COMPENSATION YMWC001520 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 7N] N / A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) 07/01/2019 07/01/202 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 07/01/2019 07/01 /2020 X STATUTE EERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Gilroy Senior Center, 7371 Hanna Street, Gilroy, CA. The City of Gilroy, its agents, officers and employees are included as Additional Insured (General Liability), per the attached. Insurance is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation Department ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S4225007/M4221900 WXNYM INSURED: YMCA of Silicon Valley POLICY #: 5068968543 POLICY PERIOD: 07/01/2019 TO 07/01/2020 COMMERCIAL GENERAL LOBJUTy CG 2026 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ rr CMEFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGAN17-ATI-ON Thft enormnent modries irkstirance PrOvIOW Under the folkotoing; COWERML GENERAL LIMILRY COVERAGE PART SCHEDULE Name 01 Additional Insumd, Fersonj#! oraanizafian(s RE: Gilroy Senior Center, 7371 Henna Street, Gilroy, CA. The City of Gilroy, its agents, officers and employees Jhfb"n,3ticn're,qukvd to complal* tfifs sch4ils t, 41 mt shown abave, will be, Whown In'the DectaTations. Section 11 — Who It, An 1nsLwW Is amended b alWo = an adcftoal Insured Ov, person(s� arargwi- z2flon(s) shown in [he Schedule, but wly vWth respect, to Nub[lft for "bodgy Injury'. 'prupert.y, damage or )-mrWA011 and advergellng "Nury* coused, in whole, or in park by'y�xw sas or OMISS�on$ Or the Wo or cmts- s3ons,of t�wa soft on yotirboMh A In the pedormance of 'your ongoing opendlonm x 0 connecClon with your pretrileas cwned by or rented to ym CO 20 26 07 04 Q 180 PE)P6089. Ine�, 2M- Page 1 of 1 INSURED: YMCA of Silicon Valley POLICY #: 5068968543 POLICY PERIOD: 07/01/2019 TO: 07/01/2020 THIS ENDORSEMENT . CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Tho'foll6wing, isladd6d,t (o Paragraph 4.a. of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS: Regardless of.Whether 6ther]rlsurance is available to an additional insured on a primary basis, this insurance' will be primary and- -:noncontrfttory if a written contract betweenyo u and the additional insured specifically requires that this insurance be primary to and noncontributory with any other insurance available to the additional insured. All other terms and conditions remain unchanged. FM 101.0.24041108 Page 1 of 1 Client#: 443977 YMCASILIC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/02/2019 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McAroy Marsh & McLennan Agency LLC PHONE 925 482-9300 FAX (A/C, No, EXt): (A/C, No): 925 482-9390 Marsh & McLennan Ins Agency LLC AM Rless: Felicia.McAroy@MarshMMA.com 1340 Treat Blvd #250 INSURER(S) AFFORDING COVERAGE NAIC # Walnut Creek, CA 94597 INSURER A: United States Fire Insurance Company 21113 INSURED YMCA of Silicon Valley INSURER B : Berkshire Hathaway Homestate Ins Co 20044 80 Saratoga Avenue INSURER C : Santa Clara, CA 95051 INSURER D : 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 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. LTR TYPE OF INSURANCE NSRLSUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMlDDlYYYY) (MMIDD/YYW) A X COMMERCIAL GENERAL LIABILITY X 5068968543 07/01 /2019 07/01 /202 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS -MADE 51 OCCUR PREMISES (Ea occurrence) $1,000,000 I MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY JECOT LOC PRODUCTS - COMP/OP AGG $1,000,000 OTHER: $ A AUTOMOBILE LIABILITY 5068968543 07/01/2019 07/01/202 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY BODILY INJURY Per accident ( ) $ AUTOS X HIRED X NON -OWNED _ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB X OCCUR 5821124616 07/01/2019 07/01/202 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 I X DED RETENTION $0 $ B IONILIT YMWC001520 ER I 07/01/2019 07/01/2020 X AND EMPS YERS' LSA AND EMPLOYERS' LIABILITY Y / N STATUTE EERH ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N] N / A E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Gilroy Senior Center, 7371 Hanna Street, Gilroy, CA. The City of Gilroy, its agents, officers and employees are included as Additional Insured (General Liability), per the attached. Insurance is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Recreation Department ACCORDANCE WITH THE POLICY. PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE 00, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S4225007/M4221900 WXNYM INSURED: YMCA of Silicon Valley POLICY #: 5068968543 POLICY PERIOD: 07/01/2019 TO 07/01/2020 COMMERCIAL GENERAL LWJUTY CG 20 26 07 04 TH1$ ENOORSEMEW CHANGES THE POLICY, PLEASE READ rr CMEFUI-LY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Tift encrorswr"I moMes Insvrance pmvidwi vrAw 0* iolwng; C 010111WERVAL GENERAL IL ILA COVERAGE PART SCHIMULE Name 01Addiflortall Insured man 14n or fta"1flo Ll RE: Gilroy Senior Center, 7371 Hanna Street, Gilroy, CA. The City of Gilroy, its agents, offico'rs and employees jt' I a n r equFred to mh'ph"' tfifs'S&'e�ole It YK9,. 's'hoWn vbgwl v#111 ba,.WWWn i I he D I I n odam on . ....... .224W Seollon 11 — Who Is -An lnsuTW,,, is smanded b in- clude = an additional Irmurstl, the. person(s) ororgwi- zalon(s) show In the Schedule, but only with rasped b labl1illy for "bodilly k1juy. "Oripped y dismage or "Wwolland adviortiolo, g irjury' coused. in whelvor in ^ by, oc% ovornMions or Ihe wts or omlti�� yo" siml sof tme ecft on your beW.- A In the, peftirmance or yow ongoing ppomflons: or B. In connecton with YoUr premises owned by or rented to ym INSURED: YMCA of Silicon Valley POLICY #: 5068968543 POLICY PERIOD: 07/01/2019 TO: 07/01/2020 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PRIMARY AND NONCONTRIBUTORY - AMENDMENT OF OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: i* COMMERCIAL GENERAL LIABILITY COVERAGE PART The .following. isaddedto. Paragraph 4.a. of SECTION IV. COMMERCIAL GENERAL LIABILITY CONDITIONS: Regardless of Whether other insurance is available to an additional insured on a primary basis, this insurance Will be primary and =ncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary to and noncontributory with any other insurance available to the additional insured. All other terms and conditions remain unchanged. FM 101.0.24041108 Page 1 of 1