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HomeMy WebLinkAboutCOI - Gilroy Gardens Family Theme Park - Expires 2021-03-30ACORC CERTIFICATE OF LIABILITY INSURANCE �..." DATE(MMIDDIYYYY) 04/01/2020 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 poiicy(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 endorq,e nppct(s). PRODUCER K&K INSURANCE GROUP, INC. P.O. BOX 2338 FORT WAYNE, IN 46801 ONTA NAME: T EVENTS & ATTRACTIONS Am No, EA: 800-553-8368 (AAIc, No): 260-459-5624 �-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: NATIONAL CASUALTY COMPANY 11991 INSURED GILROY GARDENS FAMILY THEME PARK 3050 HECKER PASS HIGHWAY GILROY, CA 95020 INSURER B: SCOTTSDALE INDEMNITY COMPANY 15580 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: C118195 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLJCY EXP (MMIDD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY OCCUR AGG Y KKI0000024233300 3/30/2020 12:01 AM 3/30/2021 12:01 AM EACH OCCURRENCE $1,000,000 CLAIMS -MADE X DAMAGE TO PREMISES (Ea Occurr nce) $300,000 X GEN'L LIQUOR LIMITS - $1,000,000/$1,000,000 MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE UNLIMITED AGGREGATE LIMIT APPLIES PER: POLICY PROJECT LOC OTHER: PRODUCTS — COMP/OP AGG $5,000,000 LEGAL LIAB TO PARTICIPANTS NC PROFESSIONAL LIABILITY B AUTOMOBILE X — `T X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY ^ X SCHEDULED AUTOS NON.OWNED AUTOS ONLY KK10000024234100 3/30/2020 12:01 AM 3/30/2021 12:01 AM COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) -PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB EXCESS LIAB DEO [1 RETENTION X OCCUR CLAIMS -MADE XKO0000024233400 3/30/2020 12:01 AM 3/30/2021 12:01 AM EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 B WO AND ANY EXECUTIVE EXCLUDED? I f es, DESCRIPTION VMS COMPEUABIUTY NSATION EMPLOYERS PROPRIETOR/PARTNER/ OFFICER/MEMBER YIN (Mandatory in NH) describe under OF OPERATIONS below N/A WCC331226A 3/30/2020 12:01 AM 3/30/2021 12:01 AM X MUTE I I OTHER E.L. EACH ACCIDENT $1,000,000 E.L DISEASE — EA EMPLOYEE $1,000,000 E.L. DISEASE —POLICY LIMIT $1,000,000 PARTICIPANT ACCIDENT AD&D Primary Mecdcal Excess Medical Weekly Indemnity DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) SEE ATTACHED ADDENDUM 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 Aco-vr ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: LOC #: CERTIFICATE: C118195 DATE ISSUED: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY K&K INSURANCE GROUP, INC. P.O. BOX 2338 FORT WAYNE, IN 46801 NAMED INSURED GILROY GARDENS FAMILY THEME PARK 3050 HECKER PASS HIGHWAYGILROY, CA 95020 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 EFFECTIVE DATE SEE ACORD 25 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: Acord25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE CITY OF GILROY, ITS OFFICERS. OFFICALS, AND EMPLOYEES ARE ADDED AS ADDITIONAL INSURED, BUT ONLY FOR LIABILITY CAUSED, IN WHOLE OR IN PART, BY THE ACTS OR OMISSIONS OF THE NAMED INSURED. ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved.