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HomeMy WebLinkAboutCOI - Gardner Family Health Network, Inc. - Expires 2024-08-01J® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 7/3 1/2023 ~ 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($), AUTHOR IZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ~2~?CT Star Metry Arthur J. Gallagher Risk Management Services, LLC ;i(JgNJo Extl: 818.539 .8623 I;,{}~ Nol: 818.539.8723 500 N Brand Boulevard , Suite 100 ~th')l~ss: Star Metrv@.aiQ.com G lendale CA 91203 INSURER($) AFFORDING COVERAGE NAIC# License#: 0D69293 INSURER A: Great American Insurance Comoanv of NY 22136 INSURED GARDFAM -02 INSURER B : ProAssurance American Mutual A Risk Retention 15647 Gardner Fam ily Health Network, Inc. INSURER C: 160 E. Virginia St, Suite 100 San Jose , CA 95112 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 542802877 REVISION NUMBER· THIS IS TO C ERTIFY THAT THE POLICIES OF IN SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FO R THE POLICY PERIOD INDICATED . N OTWITHSTANDING ANY REQUIREMENT, TERM OR CON DITI ON OF ANY CONTR ACT OR OTHER DOCUMENT WITH RESPECT T O WHICH THIS C ERTIFICATE MAY BE ISSUED OR MAY PERTA IN , THE IN SURANCE AFFORDED BY THE POLICIES DESC RIBED HEREIN IS SUBJECT T O ALL THE TERMS , EXC LUSIONS AND COND ITI ONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID C L AIMS. INSR ADPL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER /MM/DD/YYYY\ IMM/PD/YYYY\ LIMITS A X COMMERCIAL GENERAL LIABILITY y MAC 3197608 04 8/1/2023 8/1/2024 EACH OCCURR EN CE $1 ,000 ,000 -:J CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED -PREMISES IEa occurrence\ $1,000,000 -MED EXP (Any one person) $20 ,000 PERSONAL & ADV INJURY $1,000 ,000 - GEN'L AGG RE GATE LIMIT APPLIES PER : GENERAL AGGREGATE $3 ,000 ,000 ~ □PRO -□LOG $3,000 ,00 0 POLICY JECT PRODUCTS -COMP/OP AGG OTHER: $ A AUTOMOBILE LIABILITY CAP 3 197609 03 8/1/2023 8/1/2024 yg~~t~d~~tf lN GL E LIMIT $1,000 ,000 X ANY AUTO BODILY INJURY (Per person) $ -OWNED -SCHEDULED BODILY INJUR Y (Per accidenl) $ -AU TOS ON LY f--AUTOS X HIRED X NO N-OWNED PROPERTY DAMAGE $ AU TOS ONLY AUTOS ON LY IPer accident\ -f-- $ A X UMBRELLA LIAB M OCCUR UMB 3197610 04 8/1/2 023 8/1/2024 EACH OCC URREN CE $2,000 ,000 - EXCESS LIAB CLAIMS-MA DE AGG REG AT E $2,000 ,000 OED I X I RETENTION$ 1n nnn $ WORKERS COMPENSAT ION AND EMPLOYERS' LIAB ILITY Y/N I PER I STATUTE I OTH-ER ANYPROPR IETOR/PARTNER/EXECUT IVE □ E.L. EACH ACC IDE NT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE -EA EMPLOY EE $ ~m~~~ri~ ~n/gPERATIONS below E.L. DISEASE -POLICY LI MIT $ B Professional Laibility MM1048 8/1/2023 8/1/2024 Per Claim $1,000 ,000 Retro Date : 91112003 Ag gregate $3,000 ,000 Claims-Made form DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101 , Additional Remarks Schedule , may be attached if more space is required) Policy : Sex ual/Physical Abuse or Molestation Liability Policy#: MAC 3197608 04 Carrier: Great American Insurance Company of NY Policy Term: 8/1/2023 To 8/1/2024 Each Abuse limit: $1 ,000 ,000 / Aggregate: $3 ,000 ,000 City of Gilroy, its officers , representatives , agents, and employees are named additional insured with respect to the operations of the named insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy 7351 Rosanna Street AUTHORIZED REPrSENTATIVE Gilroy , CA 95020 I ~~-{) © 1988-2015 ACORD CORPORATION. All rights reserved . ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD . . ~ Nam ed insured: Gardner Family Health Network, In c. Policy number: MAC 3197608 04 CG 20 26 (Ed. 04 13) Effective Date: 8/1/2023 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART Schedu l e Name of Additional Insured Person(s) o r Organizatio n(s): City of Gilroy, its officers, representatives, agents, and employees D Information required to complete this Schedule , if not shown above , w i ll be shown in the Declarations . A. SECTION II -WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily i njury ," "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 opera t ions ; or 2. in connection w ith your premises owned by or rented to you. However: 1. the insurance afforded to such additional insured only applies to the e xte nt permitted by law; and 2. if coverage provided to the Additional Insured is required by a contract or agreement , the insurance afforded to such additional insured w ill not be broader than that which you are requi red by the contract or agreement to provide for such additional i nsured . B. With respect to the insurance afforded to these Additional Insureds , the fo llo wing is added to SECTION Ill - LIMITS OF INSURAN CE: If coverage provided to the Additional Insured is required by a contract or agreement , the most we will pay on beha lf of the Additional Insured is the amount of insurance: 1. requ i red by the contract or agreement ; or CG 20 26 (Ed . 04/13) Copyright , ISO Properties , Inc., 201 2 (Page 1 of 2) ·~··· ,'·.i . '.: . ~ * * ll. "' " bi 0 "' "' co Cl) 8 "' 0 ~ 0 § 0 0 2. available under the applicable Limits of Insurance shown in the Declarations ; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 (Ed . 04 /13) Copyright , ISO Properties , Inc., 2012 (Page 2 of 2)