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HomeMy WebLinkAboutCOI - Rebuilding Together Silicon Valley - Expires: 2025-03-15ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE Lockton Companies, LLC 444 W. 47th St., Ste. 900 Kansas City MO 64112-1906 (816) 960-9000 kcasu@lockton.com REBUILDING TOGETHER, INC. 999 N. CAPITOL STREET, NE, SUITE 330 WASHINGTON DC 20002 Philadelphia Indemnity Insurance Co.18058 Tokio Marine Specialty Insurance Company 23850 X 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 X X X 1,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX X X X 10,000 10,000,000 10,000,000 XXXXXXX XXXXXXX XXXXXXX XXXXXXX PROFESSIONAL & POLLUTION LIABILITY $1,000,000 PER CLAIM/ $1,000,000 PER CONTAMINATION / $1,000,000 PER AGGREGATE A PHPK2662813 3/15/2025 3/15/2026 A PHPK2662838 3/15/2025 3/15/2026 B PPK2665994 3/15/2025 3/15/2026 A PHUB903162 3/15/2025 3/15/2026 NOT APPLICABLE 3/15/2026 1550924 Y N N N N N 3/12/2025 Y N 21472596 21472596 XXXXXXX CITY OF GILROY HOUSING AND COMMUNITY SERVICES ATTN: SANDRA NAVA 7351 ROSANNA STREET GILROY CA 95020 CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS AND EMPLOYEES ARE NAMED ADDITIONAL INSUREDS WITH RESPECT GENERAL LIABILITY IF REQUIRED BY WRITTEN CONTRACT. THE INSURANCE PROVIDED IN THE GENERAL LIABILITY POLICY IS PRIMARY AND ANY OTHER INSURANCE SHALL BE EXCESS ONLY, AND NOT CONTRIBUTING . X See Attachment PI-NI-SCH (08/20) Philadelphia Indemnity Insurance Company Named Insured Schedule Policy Number: PHPK2662813 Rebuilding Together Anne Arundel County Rebuilding Together Arlington, Fairfax, Falls Church, Inc. Rebuilding Together Atlanta Rebuilding Together Aurora Rebuilding Together Austin Rebuilding Together Baltimore Rebuilding Together Boston Rebuilding Together Broward County Rebuilding Together Bryan/College Station Rebuilding Together Caroline County Rebuilding Together Central Alabama Rebuilding Together of Central Florida Rebuilding Together Charles County Rebuilding Together Charleston Rebuilding Together Chattanooga Rebuilding Together of the City of Angels Rebuilding Together Colorado Springs Rebuilding Together Dayton Rebuilding Together Duneland Rebuilding Together Dutchess County Rebuilding Together East Bay North Rebuilding Together Eastern Shore, Inc. Rebuilding Together El Paso Rebuilding Together Essex County Rebuilding Together Fargo-Moorhead Area Inc. PI-NI-SCH (08/20) Page 1 of 5 Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596 Rebuilding Together Fox Valley Rebuilding Together Frederick County Rebuilding Together Fredericksburg Rebuilding Together of Glynn County Rebuilding Together Greater Bismarck- Mandan Area Inc. Rebuilding Together Greater Burlington Rebuilding Together of Greater Charlotte Rebuilding Together Greater Des Moines Rebuilding Together of Greater Green Bay Rebuilding Together Greater Harrisburg Rebuilding Together Greater Haverhill Rebuilding Together Greater Newport Rebuilding Together Hartford Rebuilding Together Hebron Rebuilding Together Henry County Rebuilding Together Houston Rebuilding Together Howard County Rebuilding Together Indianapolis Rebuilding Together Jersey City Rebuilding Together Kasas City Rebuilding Together Kern County Rebuilding Together Kiamichi Country Rebuilding Together Knoxville Rebuilding Together LaPorte County PI-NI-SCH (08/20) Page 2 of 5 Rebuilding Together Lewiston-Auburn Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596 Rebuilding Together Lincoln County Rebuilding Together Litchfield County Rebuilding Together Long Beach Rebuilding Together Long Island Rebuilding Together Loudoun County Rebuilding Together Manchester Rebuilding Together Metro Chicago Rebuilding Together Metro Denver Rebuilding Together Metropolis Rebuilding Together Miami-Dade Rebuilding Together Minnesota Rebuilding Together Montgomery County Rebuilding Together Morgan County Rebuilding Together Mountain Communities Rebuilding Together Muscatine Rebuilding Together Nashville Rebuilding Together New Britain Rebuilding Together New York City Rebuilding Together North Central Florida Rebuilding Together North Jersey Rebuilding Together North Suburban Chicago Rebuilding Together North Texas Rebuilding Together Northeast Ohio Rebuilding Together of Northern Nevada PI-NI-SCH (08/20) Page 3 of 5 Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596 Rebuilding Together Oakland-East Bay Rebuilding Together Oklahoma City Rebuilding Together Olean Rebuilding Together Pacific County Rebuilding Together of the Palm Beaches Rebuilding Together Peninsula Rebuilding Together Peoria Rebuilding Together Petaluma Rebuilding Together Philadelphia Rebuilding Together Pitt County Rebuilding Together Pittsburgh Rebuilding Together Platte Valley East Rebuilding Together Portage Rebuilding Together Portland Rebuilding Together Richmond Rebuilding Together Rogue Valley Rebuilding Together Sacramento Rebuilding Together San Antonio Rebuilding Together San Diego Rebuilding Together San Francisco Rebuilding Together San Gabriel Valley Foothills Rebuilding Together Sandoval County Rebuilding Together Santa Cruz County Rebuilding Together Saratoga County PI-NI-SCH (08/20) Page 4 of 5 Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596 Rebuilding Together Seattle Rebuilding Together Sebastopol Rebuilding Together Shawnee-Johnson County Rebuilding Together Sheboygan County Rebuilding Together Silicon Valley Rebuilding Together Solano County Inc. Rebuilding Together South Lake County Rebuilding Together South Sound (Tacoma) Rebuilding Together Southeast Michigan Rebuilding Together Southern Nevada Rebuilding Together SouthWest Illinois Rebuilding Together St. Joseph County Rebuilding Together St. Louis Rebuilding Together Stephenson County Rebuilding Together Thurston County Rebuilding Together of the Triangle Rebuilding Together Tri-County Rebuilding Together Umpqua Rebuilding Together Valley of the Sun Rebuilding Together Warner Robins Rebuilding Together Washington County (OR) Rebuilding Together Waycross Rebuilding Together Worcester Rebuilding Together Yellowstone County Rebuilding Together of South Alabama PI-NI-SCH (08/20) Page 5 of 5 Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596 Attachment Code: D657014 Master ID: 1550924, Certificate ID: 21472596