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HomeMy WebLinkAboutCOI - Gilroy Gardens Family Theme Park - Expires 2022-03-30ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/21/2022 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 NAME:EVENTS & ATTRACTIONS K&K INSURANCE GROUP, INC. P.O. BOX 2338 FORT WAYNE, IN 46801 PHONE (A/C, No, Ext):800-553-8368 FAX (A/C, No):260-459-5624 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:SCOTTSDALE INDEMNITY COMPANY 15580 INSURED INSURER B:NATIONAL CASUALTY COMPANY 11991 GILROY GARDENS FAMILY THEME PARK 3050 HECKER PASS HIGHWAY GILROY, CA 95020 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C136670 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY Y KKI0000025345000 3/30/2021 12:01 AM 3/30/2022 12:01 AM EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence)$300,000 X LIQUOR LIMITS - $1,000,000/$1,000,000 AGG MED EXP (Any one person)EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN’L AGGREGATE LIMIT APPLIES PER:PRODUCTS – COMP/OP AGG $5,000,000 POLICY PROJECT X LOC LEGAL LIAB TO PARTICIPANTS NC OTHER: PROFESSIONAL LIABILITY A AUTOMOBILE LIABILITY KKI0000025345200 3/30/2021 12:01 AM 3/30/2022 12:01 AM COMBINED SINGLE LIMIT (Ea accident)$1,000,000 X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) X HIRED AUTOS ONLY X NON-OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) B UMBRELLA LIAB X OCCUR XKO0000025345300 3/30/2021 12:01 AM 3/30/2022 12:01 AM EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WCC331226A 3/30/2021 12:01 AM 3/30/2022 12:01 AM X PER STATUTE OTHER Y / N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE – EA EMPLOYEE $1,000,000 E.L. DISEASE – POLICY LIMIT $1,000,000 PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF GILROY, ITS OFFICERS. OFFICALS, AND EMPLOYEES ARE ADDED AS ADDITIONAL INSURED, BUT ONLY FOR LIABILITY CAUSED, IN WHOLE OR IN PART, BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. INSURANCE IS PRIMARY AND NON CONTRIBUTORY CERTIFICATE HOLDER CANCELLATION 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 DocuSign Envelope ID: 151E643C-7F68-4F14-8EF6-0E35050010D0DocuSign Envelope ID: 09BF0332-F91A-4B7D-8DFA-75C302C681C7 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/21/2022 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 NAME:EVENTS & ATTRACTIONS K&K INSURANCE GROUP, INC. P.O. BOX 2338 FORT WAYNE, IN 46801 PHONE (A/C, No, Ext):800-553-8368 FAX (A/C, No):260-459-5624 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:SCOTTSDALE INDEMNITY COMPANY 15580 INSURED INSURER B:NATIONAL CASUALTY COMPANY 11991 GILROY GARDENS FAMILY THEME PARK 3050 HECKER PASS HIGHWAY GILROY, CA 95020 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C136670 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY Y KKI0000025345000 3/30/2021 12:01 AM 3/30/2022 12:01 AM EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence)$300,000 X LIQUOR LIMITS - $1,000,000/$1,000,000 AGG MED EXP (Any one person)EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $5,000,000 GEN’L AGGREGATE LIMIT APPLIES PER:PRODUCTS – COMP/OP AGG $5,000,000 POLICY PROJECT X LOC LEGAL LIAB TO PARTICIPANTS NC OTHER: PROFESSIONAL LIABILITY A AUTOMOBILE LIABILITY KKI0000025345200 3/30/2021 12:01 AM 3/30/2022 12:01 AM COMBINED SINGLE LIMIT (Ea accident)$1,000,000 X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) X HIRED AUTOS ONLY X NON-OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) B UMBRELLA LIAB X OCCUR XKO0000025345300 3/30/2021 12:01 AM 3/30/2022 12:01 AM EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 DED RETENTION B WORKERS COMPENSATION AND EMPLOYERS’ LIABILITY ANY PROPRIETOR/PARTNER/ EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WCC331226A 3/30/2021 12:01 AM 3/30/2022 12:01 AM X PER STATUTE OTHER Y / N E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE – EA EMPLOYEE $1,000,000 E.L. DISEASE – POLICY LIMIT $1,000,000 PARTICIPANT ACCIDENT AD&D Primary Medical Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF GILROY, ITS OFFICERS. OFFICALS, AND EMPLOYEES ARE ADDED AS ADDITIONAL INSURED, BUT ONLY FOR LIABILITY CAUSED, IN WHOLE OR IN PART, BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. INSURANCE IS PRIMARY AND NON CONTRIBUTORY CERTIFICATE HOLDER CANCELLATION 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 DocuSign Envelope ID: 151E643C-7F68-4F14-8EF6-0E35050010D0DocuSign Envelope ID: 09BF0332-F91A-4B7D-8DFA-75C302C681C7 CG20260413 ©InsuranceServicesOffice, Inc.,2012 Page1of1 POLICYNUMBER: COMMERCIALGENERALLIABILITY CG20260413 THISENDORSEMENTCHANGESTHEPOLICY. PLEASEREADITCAREFULLY. ADDITIONALINSURED–DESIGNATED PERSONORORGANIZATION Thisendorsement modifies insurance provided under the following: COMMERCIALGENERAL LIABILITYCOVERAGE PART SCHEDULE NameOfAdditional InsuredPerson(s)OrOrganization(s): Informationrequired to complete thisSchedule, if not shown above, will be shown inthe 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 providefor suchadditional insured. B.With respect to the insurance afforded to these additional insureds, the following is added to SectionIII–LimitsOfInsurance: 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 bythe contract or agreement; or 2.Available under the applicable Limits of Insurance shown inthe Declarations; whichever isless. This endorsement shall not increase the applicable Limitsof Insurance shown in the Declarations. KKI0000025345000 SPONSORS; CO-PROMOTERS; MANAGERS OR LESSORS OF PREMISES; MORTGAGEES, ASSIGNEES OR RECEIVERS; INTERESTS FROM WHOM LAND HAS BEEN LEASED. WITH RESPECT TO AN ADDITIONAL INSURED OWNER AND/OR LESSOR OF PREMISES, THIS INSURANCE DOES NOT APPLY TO STRUCTURAL ALTERATIONS, NEW CONSTRUCTION OR DEMOLITION OPERATIONS PERFORMED BY OR FOR THAT PERSON(S) OR ORGANIZATION(S); ANY DESIGN DEFECT OR STRUCTURAL MAINTENANCE OF THE PREMISES; OR ANY PREMISES DEFECT. DocuSign Envelope ID: 151E643C-7F68-4F14-8EF6-0E35050010D0DocuSign Envelope ID: 09BF0332-F91A-4B7D-8DFA-75C302C681C7 ENDORSEMENT NO. ATTACHED TO AND FORMING A PART OF POLICY NUMBER ENDORSEMENT EFFECTIVE DATE (12:01 A.M. STANDARD TIME) NAMED INSURED AGENT NO. KKI25345000 3/30/21 Gilroy Gardens Family Theme Park, Inc. KRI-GL-79 (4-07) Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CONDITIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The Other Insurance condition of this Coverage Part is replaced by the provision marked below with an “X” in the box: Other Insurance  If other valid and collectible insurance with any other insurer including any formal self-insured re- tention programs is available to you covering a loss also covered by this Coverage Part, other than insurance that is in excess of the insurance afforded by this Coverage Part, the insurance af- forded by this Coverage Part shall be in excess of and shall not contribute with such other insur- ance. Nothing herein shall be construed to make this insurance subject to the terms, conditions and limitations of other insurance. X Coverage afforded under this Coverage Part is primary insurance and Other Insurance shall not apply as respects City of Gilroy as additional insureds. The Cancellation condition of this Coverage Part is amended by the addition of the following if an “X” is in the box:  Cancellation The following is added: It is a condition of the Policy by this Endorsement that the Policy will not be cancelled without __X___30 days’ prior written notice to: City of Gilroy, 7351 Rosanna St., Gilroy, CA 95020 _____10 day for non pay _________________________________________________________________________ and further, that the person(s) named above are not liable for the payment or assessments on this Policy. 03/30/21 AUTHORIZED REPRESENTATIVE DATE DocuSign Envelope ID: 151E643C-7F68-4F14-8EF6-0E35050010D0DocuSign Envelope ID: 09BF0332-F91A-4B7D-8DFA-75C302C681C7