Loading...
HomeMy WebLinkAboutCOI - Gardner Family Health Network - Expires 2022-08-01,® CERTIFICATE OF LIABILITY INSURANCE I PATE (MM/DD/YYYY) 8/4/2021 ___........., 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 ~~~CT Annie Lee Arthur J. Gallagher & Co. m~_NJ',.._ c-,. 818.539.8601 i FAX Insurance Brokers of CA., Inc. , fA/C. No): 818.539.8701 505 N Brand Blvd, Suite 600 ~t~ks: annie lee{ci)aia.com Glendale CA 91203 INSURER(SJ AFFORDING COVERAGE I NAIC# j License#: 0726293 INSURER A : Great American Insurance Company 16691 INSURED GARDFAM-02 INSURER B: NOR CAL Mutual Insurance Company 33200 Gardner Family Health Network INSURERC: 160 E. Virginia St, Suite 1 00 San Jose, CA 95112 INSURERD: I INSURERE: INSURERF: I COVERAGES CERTIFICATE NUMBER: 575120799 REVISION NUMBER· THlS 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 POLIGl[::S. UMJTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE iADDLjSUBRI I POUCYEFF tOLICYEXP l.lMITS LTR l!NSD1WVO, POLICY NUMBER ; IMMIOOIYYYY) MM/DDIYYYY} A X i COMMERCIALGENERALLIABIUTY y PAC 3197608 02 8/112021 8/1/2022 EACH OCCURRENCE $1.000,000 1 1 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED $1,000,000 PREMISES /Ea occurrence\ u MED EXP (Any one person) $20,000 ~ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 ~ ,--,PRO T PRODUCTS • COMP/OP AGG $3,000,000 L-J POLICY LJ JECT ~ LOC I ! OTHER: $ A AUTOMOBILE LIABILITY CAP 3197609 02 8/1/2021 8/1/2022 COMBINED SINGLE LIMIT $1,000,000 /Ea accident\ ~ ANY AUTO BOD!L Y INJURY (Per person) $ ! OWNED j SCHEDULED BODILY INJURY (Per accident) $ ,__! AUTOS ONLY '--< t~1?8wNED X I HIRED ffe?~~:J.irrt~AMAGE $ ,_j AUTOS ONLY ~ AUTOSONLY I I $ ! I A X I UMBRELLA LIAB NOCCUR UMB 3197610 02 8/112021 8/1/2022 EACH OCCURRENCE $2,000.000 t--1 I CLAIMS-MADE i EXCESS LIAB AGGREGATE $2,000,000 t DED I X I RETENTION$ 1n nno $ WORKERS COMPENSATION i ~f;TUTE I j OTH-AND EMPLOYERS' LIABILITY l ER YIN ANYPROPRIETOR/PARTNERIEXECUTIVE □ NIA E.l. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? i (Mandatory in NH) E.L DISEASE· EA EMPLOYEE, $ i g~~':;'fi~ ~gPERAT!ONS below E.L. DlSEASE • POLICY LIMIT $ B ProfeSSJonal Laibility ' 703479 8/1/2021 8/1/2022 Per Claim $1,000,000 Retro Date: 91112003 Aggregate $3,000,000 Claims-Made form i DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACOl'ID 101, Additional Remarks Schedule, may be attached if more space is required) Policy: SEXUAL ABUSE Policy#: PAC 3197608 02 Policy term: 8/1/2021 to 8/1/2022 Carrier: Great American Insurance Company Limit: $1,000,000 City of Gilroy, its officers, representatives, agents, and employees are named additional insured with respect to the operations of the named insured.Endorsement to follow. CERTIFICATE HOLDER CANCELLATION -SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TI-tE EXPIRATION DATE TI-tEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy 7351 Rosanna Street ~~ Gilroy, CA 95020 ! © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2*of2 6413