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HomeMy WebLinkAboutStanford Health Care - Insurance Certificate (2020)ACoR" CERTIFICATE OF LIABILITY INSURANCE I DATE/292o 9YY) 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 CONTACT Integro USA, Inc. dba: Integro Insurance Brokers PHONE Certificate FAX One California Street, Suite 400 fA1C. No. EYn: 404-439-8000 1 (A/C. Not: 404-439-8001 San Francisco CA 94111 ADDRESS: Certificate@epicbrokers.com INSURER($) AFFORDING COVERAGE I NAIC # INSURER A: SAFETY NATL CAS CORP 15105 INSURED STANHOS-01 INSURER B Stanford Health Care c/o Risk Management INSURERC: 300 Pasteur Dr. MC 5555 INSURERD: ---------- Stanford CA 94305 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:2072220652 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 - lADDLISUBR j POLICY EFF ' POLICY EXP LTR TYPEOFINSURANCE INSDI WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ OCCUR DAMAGE TO RENTED CLAIMS -MADE I PREMISES jE2 ocrurrence) $ _ MED EXP (Any one person) $ i PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PR ; POLICY 7 JECTO- LJ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAR CLAIMS -MADE DED I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA LDM4049541 9/1/2019 I GENERAL AGGREGATE $ I PRODUCTS - COMP/OP AGG $ $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accldenI. EACHOCCURRENCE $ AGGREGATE $ $ 911/2020 X I STPER ATUTE 1ERRH- 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 1 LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Agreement between The City of Gilroy and SHC for professional services CERTIFICATE HOLDER Gilroy Fire Department 7070 Chestnut Street Gilroy CA 95020 CANCELLATION 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2 of 2 6368