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Home My WebLink AboutCOI - Gilroy Arts Alliance - Expires 2017-10-24GILRART -01 AMANDA ACOR ®" CERTIFICATE OF LIABILITY INSURANCE DATE (MM DDNYYY) 411312017 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 poliry(ies).must 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 License # 0504035 Pacific Diversified Insurance, Inc. 15006 Concord Circle, Suite 110 4084842 -2131 Morgan Hill, CA 95037 Ha°ME cT Amanda Link, CISR, CLCS PHONE Ext : (arc YNo AiR'6 alink@pdins.com 016-06219 -NPO 10/2412016 INSURERIS) AFFORDING COVERAGE NAIC tt INSURER A: NonprOflts' Ins Alliance of CA 11845 PREMISES (Ea occurrence) INSURED INSURER B MED EXP (Any one person) INSURER C: GEN'L X Gilroy Arts Alliance INSURER D: 1,000,000 7341 Monterey Street Gilroy, CA 96020 INSURER E: 2,000,000 INSURER F: 2,000,000 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., RRLTR TYPE OF INSURANCE INSDD WVD POLICY NUMBER- MMIDDIYYYY ) POLICY EXPIMWDDfyyyyl LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR H,NOA X 016-06219 -NPO 10/2412016 10/2412017 EACKOCCURRENCE S 1,000,000 PREMISES (Ea occurrence) 500,000 X MED EXP (Any one person) 20,000 GEN'L X PERSONAL & ADV INJURY 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY 7 PRO- JECT LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMWOP AGG 2,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED UNGLE LIMIT Ea accident BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UMBRELLA LIAB EXCESSLIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DEC) 11 1 RETENTION $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN ANY ,PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory 'In NH) If yes, describe under DESCRIPTION OF OPERATIONS, below NIA STATUTE I I ER E.L. EACH ACCIDENT .., _ E.L. DISEASE - EA EMPLOY E. L. DISEASE - POLICY LIMIT I DESCRIPTION OF OPERATIONS S/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requlred) City of Gilroy, its officers, officials and employees are named as additional insureds on the General Liability Policy where required by written contract VCRS jr IVMic nvLucr% City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 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 0 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D POLICY NUMBER: 2016-06219 commERciALGiENERAL LIABILITY C , THIS ENbORSEMENT CHANGES THE, POLICY.. FLEASE. READ IT`CAREFULLY. ADDIT.101NAL. INSURIE16 - DESIGNATED PERSON OR OROMIZATION This endorsement modifies insurance prpy, ided under the g: COMMERCIAL GENERAL LIABILITY! . COVERAGE PART SCHEDULE Name Of" Itlo,nall Insured Person(s) Or Organization(s): City of Gilroy, its officers, officials, agents, employees and vounteers. Iri1am-iAtidn required ,to'complete this Sch6dulei. If not "shown above, "vv11I :b6.,sh0whinthe Declarations;. A. Section lll!-. Who ls An Insured is amended 16 include as an additional insured the perso (s) at otganizaition(s) shown r the Schedule, with in, respect to liability for "bodilyy injure dam property aW or "persona[ and , injury'' caused, . in.whole or in part, byyour acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your on 9 oing,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 .toto the extent I permitted by law, and 2. if coverage provided to the additional insured is required by a contract or agreement,." Insurance afforded to such additional'insured will not be broaderthan that .which you-are require&by the contract or agreernent:6, provide, for such,additional insured.. B. With respect to, the.. insurance afforded to these additional . I insureds, . se , . the following is- added to: Section III — Limits Of: Insurance,; If covera insured: isge,prpMqeot.o:the.a.dd,ito.nali,n. 1. required 'oy'6.-contract-or agreement, t; themostwe. will pay on'behattof.the.ad.dit I jowl Insured4s. the amount of insurance:` 1. Required by thecontract, or agreernent;: or 2. Availableuricter the appli,cab[6 Urnks of- Insurance shown In the Dedlaratons; whichever is less. This endorsement shall not increase the applicable Limb of insurance shown ilri..the Declarations, CG 20 26,64 -1 3: 0 Insurance $ery . ices,,office. Inc.. 2012 P . age I of 1. DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D NMINONPROFITS INSURANCE. ALLIANCE OF CALIFORNIA A Head jorinsurance. A Heart for Nonprofits. POLICY NUMBER 2016 - 06219' THIS ENDORSEMENT CHANGES THE POLICY..PLEASE READ: IT CAREFULLY. ADDITIONAL. INSURED PRIMARY AND NON - CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A SECTION LI — WHO IS AN INSURED is amended to include; any public entity as an additional insured for wham you are performing operations when you and'such person or organization have agreed in a written contract or written agreement that:such public entity be added as an additional! nsured(s) on.your policy, but only with respect to liability: for "bodily injury", "property damage "'or "personal and advertising injury' caused, in whole or in. part, by 1. Your negligent acts or omissions; or, 2. The negligent acts or omissions of those acting on your behalf; in the performance of your ongoing operations. No such public entity is an additional insured for liability-arising out:.of the "products- completed' operations hazard". or for liabilityarising, out of the sole negligence ofthat publlc.entity. B. With: respect to the insurance afforded to these additional,insured(s), the following additional exclusions apply. . This insurance does, not apply. to "bodily injury" or °property damage" occurring after;` 1. All work, including materials, parts or equipment furnished in :connection with such work, on the protect (other than service, maintenance or-repairs) to be performed by or on behalf of`the additional . insured(s) at the Location of the covered operations has been completed; or 2. That portion of "your work" out of which'injury or damage arises.has been put.to its;intended use :by any person or organization other than another contractor: or subcontractor engaged in performing operations far a principal as a part -ofthe same project. C. The following is added to SECTION III — LIMITS OF INSURANCE: The limits, of insurance applicable to -the additional insureds) are those specified'in he written contract between you and the additional insured(s), or the limits - available under this,!policy; whichever are ..less. These limits are part:of and not in addition tothe limits of insurance under this policy. D. With respect to the 'insurance provided -toth.e additional insurred(s), Condition 4. Other Insurance of SECTION. — COMMERCIAL GENERAL. LIABILITY CONDITIONS Is replaced bythe following: 4. Other Insurance a. Primary insurance This insurance is primary if you have, agreed in a written contract or written agreement N AGE61 12 16 Page 1 of 2 DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D 1) That this insurance be.. primary. If other insurance is also primary; 'we will share;with all that other insurance as described in c. below; or 2) The coverage afforded by this insurance is primary and non-contributory with the additional insured(s)' own insurance. Paragraphs (1) and (2) do. not apply to other insurance to which;the additional insured(s) has been added as an additional insured or to other insurance described in paragraph b. below b. Excess Insurance This insurance is excess over:. 1 Any of the other insurance, whetherprimary, excess, contingent or on any other basis: a) That is Fire, Extended Coverage, Builder's Risk, Installation r Risk or similar coverage for your work b) That is fire, lightning, or explosion insurance for premises, rented to you or temporarily occupied by you with ,permission of the owner; c) That is insurance purchased by you to cover your liability as .a tenant for "property damage" to premises temporarily occupied by you with permission: of -the; owner or d) if the loss arises out of the maintenance or use of aircraft;' "autos" or watercraft.tn;the.. extent not subJecl:16 Exclusion g. of SECTION I;,- COVERAGE A.— BODILY INJURY AND PROPERTY DAMAGE. e) That is any other insurance available to an additional insureds) under this Endorsement covering liability for damages arising out of the premises or operations, or products . completed operations, for which the additional insured(s) has been added,as an: additional insured: by that other insurance. 1) When this insurance is.excess, we will have no: duty under Coverages a or B to defend the additional insured(s) against any "suit "' if any other insurer has a duty to defend the additional insureds) against that "suit ". If no other insurer defends, .we will undertake to. do so, but we will be entitled to the additional insured(s)' rights against;all those other insurers. 2) When this insurance is excess over other insurance; we>will- pay only our share of the amount Of the loss, if any, hat exceeds.th'e sum of.. a) The total amount that all such other insurance would i ayfor the loss in the absence of this insurance; and b) 'The total of all deductible and,self- insured amounts under all that other insurance:. 3) We::will share the;remaining loss, if.any; with any other°insurance that is not described in this Excess Insurance provision and was not bought specifically toapply in excess of the Limits of'Insurance shown in the: Declarations of this Coverage: Part: C. Methods.of;shartng If ail of the other insurance available to the additional insured(s) permits contribution by equal shares, we wiI follow this method also, Under this approach each insurer"contributes equal. amounts until it has paid its.applicabte limit of insurance or none of the loss remains, whichever" comes first. If'anyotherthe other, insurance availab,leto the additional. insureds) dpes,not permit contribution: by equal shares.; we will contribute by limits. Under this,method, each insurer's share is.based on. the ratio of its applicable limit of insurance to the total'applicabl,e limits. of insurance* all insurers:. NIAGE61 12 15 .,Page. :2 of 2 DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefomonprofits.org BUSINESS AUTO COVERAGE PART DECLARATIONS PRODUCER: Pacific Diversified Insurance Services, Inc. 15005 Concord Circle, Suite 110 Morgan Hill, CA 95037 -6417 Item One: NAME OF INSURED AND MAILING ADDRESS: Gilroy Arts Alliance 7341 Monterey St. Gilroy, CA 95020 POLICY NUMBER: 2016- 06219- NPO RENEWAL OF NUMBER: 2015- 06219 -NPO POLICY PERIOD: FROM 10124/2016 TO 10/24/2017 AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE BUSINESS DESCRIPTION: Community group to support the arts IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE COVERAGE AS STATED IN THIS POLICY. Item Two SCHEDULE OF COVERAGES AND COVERED AUTOS. This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those autos" shown as covered "autos°. "Autos" are shown as covered "autos° for a particular coverage by the entry of onei or more of the symbols from the COVERED AUTOS Section of the Business Auto Coverage Form next to the name of the coverage. FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: CA 00 01 1013, CA 00 29 12 88, CA 0143 05 07, CA 20 54 1013. CA 20 55 10 13, CA 23 84 1013, CA 2385 1013, CA 99 23 1013, CA 99 33 1013, CA 99 3410 13, THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WRH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code Section 5005.1. The pooling arrangement Is not subject to all of the insurance laws of the State of California and is not subject to regulation by the Insurance Commissioner, Insurance guaranty funds are not available to pay claims in the event the risk tool becomes insolvent. COUNTERSIGNED: 09/23/2016 BY NIAC - AL -NPO AUTHORIZED REPRESENTATIVE ffi1R351 COVERED AUTOS LIMIT COVERAGES ES'covr DAALroS = a$am THE MOST WE WILL PAY FOR ANY PREMIUM aus"isss Auto C -srage F° shows ONE ACCIDENT OR LOSSwhicheutwerewwreamtos. LIABILITY CSL N/A EXCLUDED N/A HIRED APTO 8 1,000,000 CSL 50 NONOWNED AUTO 9 INCLUDED 200 AUTO MEDICAL PAYMENTS N/A EXCLUDED N/A UNINSURED MOTORIST EXCLUDED N/A UNINSURED MOTORIST -PO EXCLUDED N/A COMPREHENSIVE o° m"°"°" Adual COVERAGE 8 bfuGM1mwad aub cash value or aoon+bb..tlu:m e, Incl. s u,mms. emrtwaostofrepairTbba- whichever $500 COLLISION less Inc]. 0D COVERAGE ninue 500 °,^ n rNREE kYbF00tE0RtlR00 Haas. VOWING AND LABOR N/A SNrA for each disablemertt of a prtvate passenger "auto" N/A ESTIMATED TOTAL PREMIUM $250 FORMS AND ENDORSEMENTS APPLICABLE TO THIS COVERAGE PART AND MADE PART OF THIS POLICY AT THE TIME OF ISSUANCE: CA 00 01 1013, CA 00 29 12 88, CA 0143 05 07, CA 20 54 1013. CA 20 55 10 13, CA 23 84 1013, CA 2385 1013, CA 99 23 1013, CA 99 33 1013, CA 99 3410 13, THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS, IF APPLICABLE, TOGETHER WRH THE COMMON POLICY CONDITIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. Notice: This risk pooling contract is issued by a pooling arrangement authorized by California Corporations Code Section 5005.1. The pooling arrangement Is not subject to all of the insurance laws of the State of California and is not subject to regulation by the Insurance Commissioner, Insurance guaranty funds are not available to pay claims in the event the risk tool becomes insolvent. COUNTERSIGNED: 09/23/2016 BY NIAC - AL -NPO AUTHORIZED REPRESENTATIVE ffi1R351 DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D I CJI NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA A Head for Insurance. A Heart for Nonprofits. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) BUSINESS AUTO COVERAGE FORM www.insurancefornonprofits.org POLICY NUMBER: 2016 -06219 - NPO SCHEDULE BA Page 1 NAME INSURED: Gilroy Arts Alliance Item Three: SCHEDULE OF COVERED AUTOS YOU OWN DESCRIPTION DEDUCTIBLES apply only if TOWING coverage is provided as & LABOR COVERED YEAR, MODEL, TRADE NAME, CLASS indicated below. AUTO BODYTYPE, SERIAL NUMBER(S) VIN TERR. CODE OTHER THAN Limit perNO. COLLISION COLLISION Disablement NO OWNED AUTOS N/A PREMIUMS: COVERAGE IS PROVIDED ONLY IF A PREMIUM CHARGE IS INDICATED. COVERED PHYSICAL DAMAGE TOWING ADDITIONAL INSURED/ LOSS PAYEE: AUTO NO. NON- OWNED HIRED MED UM/ LIABILITY PAY UIM COLL. COMP. AND LABOR Eacopt for towing, all physical damage lam is payable mawapp— atth.bm.YofI.. S.b.ifa,.n mereatmayappaar Sc ed,la A1. NO /H 200 Hired PD 50 Hired Physical Damage Deductibles: Comprehensive: $500 Collision: $500 Signature NIA za 09/23/2016 Date DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D zi ray Center, for the Art A' t r April 25, 2017 Maria DeLeon City of Gilroy . 7351 Rosanna Street Gilroy, CA 95020 Dear Maria: On behalf of the Gilroy Arts Alliance Board, i am confirming our organization does not have a direct hire employee. The Executive Director position, currently filled by Kevin Heath, is a contract staff (1099) position. By direction from Pacific Diversified, our insurance broker, our organization is not required to provide workers comp coverage for this position or for our volr.rnteers. if you have any other questions, please feel free to contact me at 408- 406 -5448. Thank you. Sincerely, Alan Obata Vice President, Gili'OV Arts Alliancel Gilroy Center for the arts e Jiren/ ilyts.Aii:.r,..U., ln. o•i1.'r' I Afqirrei'ey Strr,r frhy, CA 91i(9'e' 444 8 42Wb '.) Li C ^14'A r NA DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D