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HomeMy WebLinkAboutCOI - Gardner Family Health Network - Expires 2023-08-01A` CPREP CERTIFICATE OF LIABILITY INSURANCE MM/OD /DD/YY YYY) DATE E/2022 (M 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 Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. 500 N. Brand Blvd, Suite 100 Glendale CA 91203 License#: 0726293 CONTACT NAME: Star Metry PHONE FAX rA c. No. Exu: 818.539.8623 (A/C, No): 818.539.8723 ADDRESS: Star Metry@ajg.com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Great American Insurance Company 16691 INSURED GARDFAM-02 Gardner Family Health Network 160 E. Virginia St, Suite 100 San Jose, CA 95112 INSURER B : NORCAL Insurance Company 33200 wsuRERc: INSURERD: { INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:576749580 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES NOTWITHSTANDING ANY REQUIREMENT, MAY BE ISSUED OR MAY AND CONDITIONS OF SUCH TYPE OF INSURANCE 1 OF INSURANCE PERTAIN, POLICIES. ADDL SUBR INSD: WVD LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY LIMITS SHOWN MAY HAVE BEEN REDUCED POLICY NUMBER ISSUED TO CONTRACT THE POLICIES BY I POLICY EFF (MM/DD/YYYY) THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, PAID CLAIMS. POLICY EXP (MM/DD/YYYY) I LIMITS A X COMMERCIAL GENERAL LIABILITY Y PAC 3197608 03 8/1/2022 I 8/1/2023 '; EACH OCCURRENCE $1.000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES.LEa occurrence] $ 1,000,000 MED EXP (Any one person) I $ 20,000 I PERSONAL & ADV INJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES__PER: 1 F GENERAL AGGREGATE $ 3,000,000 POLICY I I JECT PRO- ' X ' LOC 1 PRODUCTS - COMP/OP AGG $ 3,000,000 �. OTHER: $ A AUTOMOBILE UABILITY X I ANY AUTO CAP 3197609 03 8/1/2022 8/1/2023 COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) $ 1,000.000 $ — OWNED j , SCHEDULED I AUTOS ONLY i AUTOS BODILY INJURY (Per accident) $ X I HIRED i X I NON -OWNED AUTOS ONLY i : AUTOS ONLY i PROPERTY DAMAGE f_(Per accident) $ A X UMBRELLALIAB % X OCCUR �' UMB 3197610 02 8/1/2022 8/1/2023 1 EACH OCCURRENCE $2.000.000 EXCESS LIAB ! j CLAIMS -MADE AGGREGATE $2.000,000 I DED I XRETENTION $ in nnn $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N N / A"— ' 1 PER I OTH- STATUTE j ER I E.L. EACH ACCIDENT ---" , E.L. DISEASE - EA EMPLOYEE $ $ ANYPROPRIETOR.%PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATIONS below i E.L. DISEASE - POLICY LIMIT $ 6 Professional Laibility Retro Date: 9/1/2003 Claims -Made form 703479 8/1/2022 8/1/2023 I Per Claim . Aggregate $1,000,000 $3,000,000 DESCRIPTION City OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be of Gilroy. its officers, representatives. agents, and employees are named additional attached II more space Is required) insured with respect to the operations of the named insured � a CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 S E P 1 2022 GILROY CITY CLERK'S OFFICE 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 UT11HORIZEDREP ESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2` of 4 4185 Named insured: Gardner Family Health Network Policy number: PAC 3197608 03 Effective Date: 8/ 1 / 2022 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 (Ed. 04 13) ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedule Name of Additional Insured Person(s) or Organization(s): City of Gilroy, its oliicers, representatives, agents, and employees Information required to complete this Schedule. if not shown above, will be shown in the 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 provide for such additional insured. B. With respect to the insurance afforded to these Additional Insureds, the following is added to SECTION III - LIMITS OF INSURANCE: 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 by the contract or agreement; or Copyright, ISO Properties, Inc., 2012 CG 20 26 (Ed. 04/13) (Page 1 of 2) 3*of4 4155 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. Copyright, ISO Properties. Inc., 2012 CG 20 26 (Ed. 04/13) (Page 2 of 2) 4*of4 4185 Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. 500 N. Brand Boulevard, Suite 100 Glendale, CA 91203 4185 1 MB 0.512 4185 IIIII"IIiIIIIIIIIIIIII"II'III""IIIIIIuI'IIIIIIIIIIIIIIIIIIIII CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020-6141 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing: 1. Confirmation that a certificate of insurance is no longer required; or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code found in the Insured section on the enclosed certificate. An example of this code is XXXXXX-01 4. This Certificate Number: 576749580 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https://www.ajg.com/us/privacy-policy/. 1*of4 4185