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HomeMy WebLinkAboutEmpowering Our Community - Insurance Certificate (2020)ACOR" CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/D19 ) 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 CONTI NAME: Jennifer Wells ONE CONNECT INSURANCE 1PHONE Fxt)• (888)565 1326 (A/c.Nol: 716 Ca Itola Ave Ste B EMAIL p� AODREss: infoCa)1connectinsurance.com Capitola, CA 95010 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : N IAC 524126 INSURED INSURERB: Employer$ 11512 Empowering Our Community for Success INSURER C E.O.C.S. I INSURER D 1764 Queenstown Drive I INSURER E: San Jose, CA 95132 I 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR 1NgD VJV❑ POLICY NUMBER (MMIDD/YYYYI (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS OCCUR DAMAGE TO RENTED -MADE /� PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 20,000 A X 2019-45570 06/20/19 06/20/20 I PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY ❑PRO- ❑ JECT LOC PRODUCTS - COMP/OPAGG $ 1,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY (Per person) $ OWNED F—] A AUTOSONLY AUTOSULED 201 9-45570 06/20/19 06/20/20 I BODILY INJURY (Per accident) $ XHIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY N (Per accident) UMBRELLA LIAR OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X I PER AND EMPLOYERS' LIABILITY Y / N STATUTE EORH ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLD? UDEN / A ❑ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability Professional Liability 1,000,000 A Improper Sexual Conduct 2019-45570 06/20/19 06/20/20 Imorooer Sexual Conduct 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Strete ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPR' SENTATIVE ©1988-2015 A&&D CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2019-45570 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFULLY. 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 officers, representatives, agents and employees Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy, and for which a certificate of insurance naming such person or organization as additional insured has been issued, but only with respect to their liability arising out of their requirements for certain performance placed upon on you, as a nonprofit organization, in consideration for funding or financial contributions you receive from them. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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: A. in the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. C. The insurance shall be primary as respects the additional insured shown in the schedule above, or if excess, shall stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. in either event, any other insurance maintained by the additional insured scheduled above shall be in excess of this insurance and shall not be called upon to contribute with it. CG 20 26 07 04 U ISO Property, Inc., 2004 Page 1 of 1 POLICYHOLDER COPY NA P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-07-2019 GROUP: POLICY NUMBER: 9261123-2019 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 09-20-2020 09-20-2019/09-20-2020 CITY OF GILROY NA 7351 ROSANNA ST GILROY CA 95020-6141 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. v Authorized Representative EMPLOYER'S LIABILITY LIMIT EMPLOYER President and CEO INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. EMPOWERING OUR COMMUNITY FOR SUCCESS (A NON PROFIT PUBLIC BENEFIT CORP) 1501 WARBURTON AVE SANTA CLARA CA 95050 [SAZ,CNj (REV.7-2014) PRINTED : 10-07-2019