HomeMy WebLinkAboutCOI - South Santa Clara County FPD - Expires 2021-07-01DATE (MMrODNYYY)
a�� o CERTIFICATE OF LIABILITY INSURANCE
6l29/2020
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 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 NACONTACT ME:
Arthur J. Gallagher & Co. PHONE 415-546.9300 _ ac No : 415-536-8499—
Insurance Brokers of CA. Inc., License #0726293 E-MAIL
1255 Battery Street #450 ADDRESS:
San Francisco CA 94111 INSUREWS11 AFFORDING COVERAGE NAIC 9
INSURED- ------------- ----�
South Santa Clara County FPD
15670 Monterey Street
Morgan Hill, CA 95037
INSURER A: Allied World Assurance Company Ltd
FIREAGE-01 INSURER B :
INSURER C :
INSURER D :--
INSURER E :
COVERAGES CERTIFICATE NUMBER: 183751294 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 — jADDLiSUBRi
LTR TYPE OF INSURANCE INSD WVD 1 POLICY NUMBER
-i POLICY EFF ' POLICY EXP
MM/DDIYYYY MMIDDIYYY LIMITS
A
X 'COMMERCIAL GENERAL LIABILITY Y
JPAPKG-00237-OOF-02
7l1/2020 7/1/2021 EACH OCCURRENCE
$1.000.000
---DAMAGE
CLAIMS -MADE X OCCUR
-~SIR
TO RE
PREMISES Ea occurren
_
$1 000,000
X 0
MED EXP.(Any one person)
$10,000 _
_
PERSONAL & ADV INJURY
$1.000.000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$10,000,000
X POLICY PRO- LOC
— JECT
PRODUCTS - COMPIOP AGG
$10.000,000
-
OTHER:
1$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accdent
$
__ _
ANY AUTO
BODILY INJURY (Per person)
$
OWNED— SCHEDULED
BODILY INJURY (Per accident) $
AUTOS ONLY 'AUTOS
—
HIRED NON -OWNED
PROPERTY DAMAGE
$-
AUTOS ONLY �_ AUTOS ONLY
!_ (Per accident)- _ i -
$
UMBRELLA LIAR OCCUR
EACH OCCURRENCE
1
$
$— _
EXCESS LIAB _ CLAIMS -MADE
AGGREGATE _
DED RETENTION $
$
WORKERS COMPENSATION
I ERH
AND EMPLOYERS' LIABILITY IN
Y❑
— STATUTE
$
ANYPROPRIETOR,PARTNERIEXECUTIVE E.L._EACH_ ACCIDENT
OFFICERWEMBEREXCLUDED? NIA A
_
-- - ---- -
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYEE
$
11 yes, describe under
DESCRIPTION OF OPERATIONS below i
E.L. DISEASE - POLICY LIMIT
$
i
IIi
I
I
I
1 I
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
City of Gilroy, its Officers, Officials and Employees are also named as Additional Insureds as respects the shared of
Battalion Chief Agreement.
CERTIFICATE HOLDER CANCELLATION
City of Gilroy
7351 Rosanna Street
Gilroy CA 95020
USA
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
rJt.r,c�ly
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
2' of 3 16296
i
POLICY NUMBER:, JPAPKG-00237-OOF-02
I
ADDITIONAL INSURED - AUTOMATIC
THIS ENDORSEMENT CHANGES THE COVERAGE FORM.
PLEASE READ IT CAREFULLY.
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SECTION II. — WHO IS AN INSURED is amended to include as an insured any person or organization
but only with respect to the following:
A. 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 premises owned by or rented to you;
B. Liability arising out of the ownership, maintenance or use of premises leased to you and subject to
the following additional exclusions:
1. any 'occurrence" which takes place after you cease to be a tenant at that premises.
2. structural alterations, new construction or demolition operations performed by or on behalf of
the person or organization you have leased from.
FR-GL 00006 00 (05/15) Page 1 of 1
Includes copyrighted material of Insurance Services Offices, Inc. with its permission.
T of 3 16296