HomeMy WebLinkAboutCOI - County of Santa Clara - ExpiresDocuSign Envelope ID: FC952AC1-CBB7-4051-8AD6-B3997B958BCB
County of Santa Clara
Office of the County Executive
Office of Risk Management
Liability/Property Insurance Division
2310 North First Street, Suite 203
San Jose, California 95131
Tel. No. (408) 441-4340 FAX (408) 441-4341
This is to Certify to:
CERTIFICATE OF COVERAGE
ISSUED BY
COUNTY OF SANTA CLARA
City of Gilroy
7351 Rosanna Street
Gilroy, CA 95020
Attn: Bryce Atkins
Ins. Cert. No. FY23-009
That the following described coverages are in force on this date as set forth below:
Assured: County of Santa Clara
70 W. Heddinq Street
San Jose, CA 95110
Insurer
1. Self -Funded Retention
2. PRISM
TvDe of Coverage
Expiration
Continuous
07/01/2022
Limits
1. Workers' Compensation $4,000,000 Per Occurrence
2. Excess Workers' Compensation Statutory
This certificate of coverage is provided by the County of Santa Clara to the above named certificate holder.
The coverage specified herein will not be cancelled or reduced without thirty (30) days written notice from
County of Santa Clara to the certificate holder. This certificate pertains to the agreement between the City
of Gilroy and the Santa Clara County Library District for the Construction Work in Patio Area of Gilroy
Library. This certificate is valid from July 1, 2022 to December 31, 2022.
DocuSigned by:
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Hank Ford
Insurance Contracts & Claims Manager
June 14, 2022
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FY23-009GiIroyCity&SCCLibraryDist
Board of Supervisors: Mike Wasserman, Cindy Chavez, Otto Lee, Susan Ellenberg, S. Joseph Simitian
County Executive: Jeffrey V. Smith