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HomeMy WebLinkAboutCOI - NHA Advisors, LLC - Expires 2023-01-23CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/01/2022 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 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 CONTACT NAME:K T L Business Insurance Services, Inc. KEVIN LEVINE K T L BUSINESS INSURANCE SERVICES, INC. 322 8TH STREET SUITE # 101 DEL MAR CA 92014 PHONE (A/C, No, Ext):(858) 350-0555 FAX (A/C, No):(858) 350-0556 E-MAIL ADDRESS:kevin@ktlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Agency Lic#: CA # 0D86601 INSURER A :Valley Forge Insurance Company 20508 INSURED NHA ADVISORS, LLC 4040 CIVIC CENTER DR STE 200 SAN RAFAEL CA 94903 INSURER B :Hartford Property & Casualty 34690 Underwriters at Lloyd's, LondonINSURER C : INSURER D: INSURER E : COVERAGES CERTIFICATE NUMBER:91651 INSURER F : 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 (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY 6025083654 01/23/22 01/23/23 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurence)$300,000 MED. EXP (Any one person)$10,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $4,000,000 OTHER:$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person)$ $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident)$ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE (per accident)$ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED EXCESS LIAB RETENTION $$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 72WECAA9ESI 11/08/21 11/08/22 X PER STATUTE OTH- ER Y / N E.L. EACH ACCIDENT $1,000,000ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?N / A E.L. DISEASE-EA EMPLOYEE $1,000,000(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 C PROFESSIONAL LIABILITY MPL437400022 02/06/22 02/06/23 AGGREGATE $2,000,000 EACG CLAIM $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF GILROY, ITS OFFICERS AND EMPLOYEES NAMED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER ATTACHED BLANKET ENDORSEMENT AND POLICY FORM. 10-DAY NOTICE OF CANCELLATION GIVEN FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street 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 Attention: Kevin Levine ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 03/08/2022 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 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 CONTACT NAME:K T L Business Insurance Services, Inc. KEVIN LEVINE K T L BUSINESS INSURANCE SERVICES, INC. 322 8TH STREET SUITE # 101 DEL MAR CA 92014 PHONE (A/C, No, Ext):(858) 350-0555 FAX (A/C, No):(858) 350-0556 E-MAIL ADDRESS:kevin@ktlinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Agency Lic#: CA # 0D86601 INSURER A :Valley Forge Insurance Company 20508 INSURED NHA ADVISORS, LLC 4040 CIVIC CENTER DR STE 200 SAN RAFAEL CA 94903 INSURER B :Hartford Property & Casualty 34690 Underwriters at Lloyd's, LondonINSURER C : INSURER D: INSURER E : COVERAGES CERTIFICATE NUMBER:91718 INSURER F : 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 (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY 6025083654 01/23/22 01/23/23 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurence)$300,000 MED. EXP (Any one person)$10,000 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG $4,000,000 OTHER:$ A AUTOMOBILE LIABILITY 6025083654 01/23/22 01/23/23 COMBINED SINGLE LIMIT (Ea accident)1,000,000 ANY AUTO BODILY INJURY (Per person)$ $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident)$ X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE (per accident)$ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED EXCESS LIAB RETENTION $$ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 72WECAA9ESI 11/08/21 11/08/22 X PER STATUTE OTH- ER Y / N E.L. EACH ACCIDENT $1,000,000ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED?N / A E.L. DISEASE-EA EMPLOYEE $1,000,000(Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1,000,000 C PROFESSIONAL LIABILITY MPL437400022 02/06/22 02/06/23 AGGREGATE $2,000,000 EACG CLAIM $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CITY OF GILROY, ITS OFFICERS AND EMPLOYEES NAMED AS ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY AS PER ATTACHED BLANKET ENDORSEMENT AND POLICY FORM. 10-DAY NOTICE OF CANCELLATION GIVEN FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street 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 Attention: Kevin Levine ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All rights reserved. DocuSign Envelope ID: C8F8A595-1EBD-4AA7-8332-51A9E09BCF9D