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HomeMy WebLinkAboutCOI - Jenny Ray-Camara dba Jenny Ray Camara - Expires 2022-08-27RLI@ City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Policy Number: BOP1047197 [Page intentionally left blank.] BOP1047197 RLI Insurance Company Renewal of Number Policy No. BOP1047197 9025 North Lindbergh Drive Peoria, IL 61615 Form Applicable HOME BUSINESS INSURANCE POLICY DECLARATIONS D Standard !XI Special Named Insured and Mailing Address: Jenny Ray-Camara DBA Jenny: Ray Camara 194 Paseo Gularte San Juan Bautista, CA 95045 Administrator Name and Mailing Address: Lindbergh Insurance Agency 9025 N Lindbergh Drive Peoria, IL 61615 Policy Period: Insured's Brokering Agent: From 08/27/21 to 08/27/22 at 12:01 A.M.* Standard Time at your mailing address shown above. *Exceptions: 12:00 noon in Michigan, North Carolina, and Puerto Rico. In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. BUSINESS DESCRIPTION Form of Business: Ix] Individual D Joint Venture/Partnership 0 LLC D Organization (Any Other) Business description: Personal Fitness Trainer DESCRIBED PREMISES ADDITIONAL INTEREST 194 Paseo Gularte San Juan Bautista, CA 95045 PROPERTY PREM. NO. 1 I BLDG. NO. PREM. NO. 2 I BLDG. NO. PREM. NO. 3 I BLDG. NO. Limits of Insurance for I I I Buildings $ NIA $ N/A $ N/A *Actual Cash Value -Buildings Option (Y/N) *Automatic Increase -Business Personal Property Limit(%) 4% % Business Personal Property $5200 $ $ Deductible $ 250 Minimum Earned Premium $ 92 Additonal/Optional Coverages -Applicable only if an "X" Limits of Insurance is shown in the boxes below: 1. D Electronic Data Processing $ 2. D Money and Securities (Special Form only) $ Inside the Premises □ $ Outside the Premises 3. D Jewelry and Watch Increased Theft Coverage 4. [x] Other (specify) Additional Insured, Terrorism LIABILITY AND MEDICAL PAYMENTS Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II -Liability in the Businessowners Coverage Form and any attached endorsements. I imits of Insurance Liability and Medical Expenses $1,000,000 per occurrence Medical Expenses $5,000 per person Damage to Premises Rented to You $50,000 any one premises Other Than Products/Completed Operations Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000 FORMS AND ENDORSEMENTS Forms and Endorsements made part of this policy at time of issue: Please see reverse side. PREMIUM Policy Florida Florida Total Premium$ 368.00 HCF Surcharge $ 0.00 CPIC Surcharge $0.00 Annual Premium $368.00 *(', fr,r ,;;-;_, Arte::: r,f T,,_,.~,;.,,m 'l:1 nn Countersigned: By Authorized Representative THESE DECLARATIONS, TOGETHER WITH THE COVERAGE FORM(S), COMMON POLICY CONDITIONS AND FORMS, AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THERE OF, COMPLETE THE ABOVE NUMBERED POLICY. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1984, 1985 07/13/21 Lindbergh Insurance Agency/88502 Lindbergh Insurance Agency/99999 BOP 0001 (01/10) % FORMS AND ENDORSEMENTS (continued) Forms and Endorsements made part of this policy at time of issue: BP 00 03 (07/13) BUSINESSOWNERS COVERAGE FORM BOP 402 (07/02) ABUSE OR MOLESTATION EXCLUSION BOP 405 (01/10) AMENDMENT TO PROFESSIONAL LIABILITY EXCLUSION BOP 410 (01/13) PERSONAL PROPERTY OFF PREMISES LIMITS ENDORSEMENT BOP 413 (07/02) EXCLUSION -WEIGHT LOSS PRODUCTS BOP 414 (01/13) EXCLUSION -MEDICAL EXPENSES COVERAGE BOP 415 (07/02) DEFINITION -VOLUNTEER WORKER BOP 426 (11/07) AUTOMATIC INCREASE -BUSINESS PERSONAL PROPERTY BOP 432 (11/07) ELECTRONIC DATA COVERAGE EXCLUSION BOP 434 (01/13) EXCLUSION -COVERAGE EXTENSIONS BOP 440 (09/11) CALIFORNIA CHANGES BOP 441 (01/13) AGRICULTURAL OPERATIONS EXCLUSION BOP 442 (01/13) RENTAL DWELLING EXCLUSION BP 0417 (01/10) EMPLOYMENT-RELATED PRACTICES EXCLUSION BP 05 26 (01/15) EXCLUSION OF CERTIFIED ACTS OF TERRORISM INVOLVING NUCLEAR BP 05 77 (01/06) FUNGI OR BACTERIA EXCLUSION (LIABILITY) BP 05 98 (07/13) AMENDMENT OF INSURED CONTRACT DEFINITION BP 07 04 (01/06) BUSINESS LIABILITY COVERAGE -PROPERTY DAMAGE LIABILITY DEDUCTIBLE BP 1419 (01/10) EXCLUSION -DAMAGE TO WORK PERFORMED BY SUBCONTRACTORS ON YOUR BEHALF BP 14 86 (07/13) COMMUNICABLE DIS~SE EXCLUSION BP 15 05 (05/14) EXCLUSION-ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION BP 15 11 (12/16) EXCLUSION -UNMANNED AIRCRAFT BP 14 88 (07/13) PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION BP 04 02 (07/13) ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES ILF 0001C (04/16) SIGNATURE PAGE-COMMERCIAL LINES [Page intentionally left blank.] Policy Number: BOP1047197 RLI Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph H. Other Insurance of Section Ill -Common Policy Conditions and super-sedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek con-tribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. BP14880713 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: BOP1047197 RU Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Section II -Liability is amended as follows: A. The following is added to Paragraph C. Who Is An Insured: 3. The person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability arising out of the owner-ship, maintenance or use of that part of the prem-ises leased to you and shown in the Schedule. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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 provide for such additional insured. B. With respect to the insurance afforded to these additional insureds the following additional exclusions apply: This insurance does not apply to: 1. Any "occurrence" that takes place after you cease to be a tenant in the premises described in the Schedule. 2. Structural alterations, new construction or demo-lition operations performed by or for the person(s) or organization(s) designated in the Schedule. C. With respect to the insurance afforded to these addi-tional insureds, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance: If coverage provided to the additional insured is re-quired by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. SCHEDULE Designation Of Premises (Part Leased To You}: Name Of Person(s) Or Organization(s) (Additional Insured}: City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 BP04020713 © Insurance Services Office, Inc., 2012 Page 1 of 2 ADDITIONAL INSURED -MANAGERS OR LESSORS OF PREMISES -Cont'd. Additional Premium: $20 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. BP 04 02 07 13 © Insurance Services Office, Inc., 2012 Page 2 of 2