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HomeMy WebLinkAboutCOI - CivicPlus, LLC - Expires 2021-05-17Page 1 of 1 60 ACORD, 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. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 05/14/2020 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, If SUBROGATION IS WAIVED, subject to the terms and conditions this certificate does not confer rights to the certificate holder in lieu PRODUCER Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA INSURED CivicPlus 302 S 4th Street, Suite 500 Manhattan, KS 66502 the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. of the policy, certain policies may require an endorsement. A statement on of such endorsement(s). CONTACT Willis Towers Watson Certificate Center NAME: PHONE 1-877-945-7378 INC. No. Exit: E-MAIL certificates@willis.com ADDRESS: FAX (A/C, No): 1-888-467-2378 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Great Northern Insurance Company INSURER B Federal Insurance Company 20303 20281 INSURER C : INSURER D : INSURER E : INSURER F : W16465448 REVISION NUMBER: l.,V r L., ..- --v --.. ........_ .-------... 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. I NSR. .ADDL,SUBR, POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE MI LTR � INSD WVD POLICY NUMBER (MDD/YYYY) I (MMiDD1VYYY) '�, A X COMMERCIAL GENERAL LIABILITY 3602-53-12 05/17/2020 ; EACH OCCURRENCE $ 1 2,000, 000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED , PREMISES (Ea occurrence) $_ MED EXP (Any one person) $ 2, 000, 000 10, 000 05/17/2021: PERSONAL & ADV INJURY '. $ 1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEC LOC ' GENERAL AGGREGATE : $ PRODUCTS - COMP/OP AGO $ 2,000, 000 2,000, 000 OTHER: AUTOMOBILE LIABILITY X , ANY AUTO 7358-87-92 05/17/2020!05/17/2021 ' ::. COMBINED SINGLE LIMIT $ (Ea accident)_ BODILY INJURY (Per person) $ 1,000, 000 OWNED SCHEDULED ONLY ' AUTOS BODILY INJURY (Per accident), $ AUTOS HIRED 1 NON -OWNED AUTOS ONLY I 1 AUTOS ONLY PROPERTY DAMAGE $ (Per accident) ':$ r I B UMBRELLALIAB X OCCUR , 7989-49-14 05/17/2020 I 05/17/2021' EACH OCCURRENCE $ 5,000, 000 X '. EXCESS LIAB ; CLAIMS -MADE AGGREGATE_ $ $ 5,000, 000 DED X RETENTIONS 0 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y i N NiA (20) 7174-92-49 05/17/2020 TH- X . PERTUTE OER E.L. EACH ACCIDENT $ --------------------------1- ---- E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 1,000,000 ANYPROPRIETOR'PARTNERIEXECUTIVE OFFICERiMEMBEREXCLUDED? (Mandatory In NH) II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, officials and employees Gilroy CA 95020 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 REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SA ID: 19617191 BATCH: 1680264 2of2 229I