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HomeMy WebLinkAboutCOI - Community Solutions - Expires 2020-09-01PHILADELPHIA INDEMNITY INSURANCE COMPANY 1-877-438-7459 ONE BALA PLAZA, SUITE 100 BALA CYNWYD PA 19004 REINSTATEMENT NOTICE Named Insured & Mailing Address: COMMUNITY SOLUTIONS FOR CHILDREN, 9015 MURRAY AVE STE 100 GILROY CA 95020-3617 Producer: 0013902 ACRISURE OF CALIFORNIA, LLC DBA SUHR 910 E HAMILTON AVE STE 410 CAMPBELL CA 95008-6438 Policy No.: PHPK1874749 Type of Policy: PACKAGE You recently received a notice advising this policy was being cancelled effective 08/19/2019 . This notice is to advise that the policy is being reinstated without lapse in coverage. Other Party of Interest CITY OF GILROY, ITS OFFICERS, 7351 ROSANNA ST GILROY CA 95020-6141 FORM# CT969897CA51995 ODEN 3.0.19.04a iiU �1 L'1[—UOU�6/d Copy for Other Interests CACT19 08052019S N NY Page 1 of 1 C COMMU01 OP ID: CD �� A---- CERTIFICATE OF LIABILITY INSURANCE DATE/03/2019Y) 09/03/2019 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 408-510-5440 Suhr Risk Services 910 E. Hamilton Ave. Suite 410 Campbell, CA 95008 Jeff State, CRIS, CWCS CONTACT NAME: PHONE FAX (A/C, No, Bet): 408-510-5440 (NC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Indemnity Ins. 18058 INSURED CommunitySolutions for Children, Fmilies and Indiv 9015 Murray Avenue #100 Gilroy, CA 95020 INSURER B : Cypress Insurance Company (CA) 10855 INSURER C : Fidelity & Deposit Company 39306 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF IMM/DD/YYYYI POLICY EXP IMM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY X PHPK2031403 PHPK2031403 09/01/2019 09/01/2019 09/01/2020 09/01/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR PREMISEE SO(Eocu RENTEDnce) $ 1,000,000 X Prof Liability MED EXP (Any one person) $ 20,000 PERSONAL & ADV INJURY S 1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- PRO- JECT PER: LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS-COMP/OPAGG 3,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS AUTOS ONLY PHPK2031403 09/01/2019 09/01/2020 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) S (Per aPROPccident) Y DAMAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB691787 09/01/2019 09/01/2020 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X RETENT ON $ 10000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A COWC034088 07/01/2019 07/01/2020 X ER P STATUTE OTH- ER E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 S A C Crime Crime Excess PHPK2031403 CCP006841605 09/01/2019 07/01/2019 09/01/2020 07/01/2020 EE Theft EE Theft 500,000 7,700,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Proof of Coverage City of Gilroy, its Officers, Representatives, Agents and Employees are named as additional insured per attached endorsement form. CERTIFICATE HOLDER CITYGIL Cityof GilroyTHE Calgrip One program 7351 Rosanna Street Gilroy, CA 95020-6197 --------------- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE +144 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PHPK2031403 PI-GLD-HS (10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non -Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments — Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments — Bail Bonds $5,000 5 Supplementary Payment — Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement — Janitorial Services Client Coverage $10,000 limit 6 Additional Insured — Newly Acquired Time Period Amended 6 Additional Insured — Medical Directors and Administrators Included 7 Additional Insured — Managers and Supervisors (with Fellow Employee Coverage) Included 7 Additional Insured — Broadened Named Insured Included 7 Additional Insured — Funding Source Included 7 Additional Insured — Home Care Providers Included 7 Additional Insured — Managers, Landlords, or Lessors of Premises Included 7 Additional Insured — Lessor of Leased Equipment Included 7 Additional Insured — Grantor of Permits Included 8 Additional Insured — Vendor Included 8 Additional Insured — Franchisor Included 9 Additional Insured — When Required by Contract Included 9 Additional Insured — Owners, Lessees, or Contractors Included 9 Additional Insured — State or Political Subdivisions Included 10 Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company