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HomeMy WebLinkAboutCOI - Gilroy Arts Alliance - Expires 2021-10-24SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 3/18/2021 Pacific Diversified Insurance Services 15005 Concord Circle Suite 110 Morgan Hill CA 95037 408-842-2131 408-842-0867 alink@pdins.com License#:0K07568 Nonprofits'Insurance Alliance of California GILRART-01 Gilroy Arts Alliance Kevin Heath 7341 Monterey Street Gilroy CA 95020 828331464 A X 1,000,000 X 500,000 20,000 1,000,000 2,000,000 2020-06219 10/24/2020 10/24/2021 2,000,000 A Directors &Officers 2020-06219-DO-NPO 10/24/2020 10/24/2021 Limit 1,000,000 The City of Gilroy,its officers,representatives,agents,and employees are named as Additional Insured per the attached carrier form provided a written contract or agreement is in place. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D _____________________________________________________________________________________ 7341 Monterey Street Gilroy CA 408-310-0422 April 18, 2021 Robert Carrera City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Dear Robert: On behalf of the Gilroy Arts Alliance Board, I am confirming that our organization does not hire paid employees. Our organization is Volunteers only, and any work that may need to be performed is on an independent contractor (1099) basis. By direction of Nonprofit Insurance, our insurance broker, our organization is not required to carry workers comp coverage for our volunteers. If you have any further questions, please feel free to contact me at 408-483-5020. Thank you. Sincerely, Marianne Eichenbaum President , Gilroy Arts Alliance/Center for the Arts DocuSign Envelope ID: F3D35D67-36D4-4C38-8831-5BE0D2F46A4D