Loading...
HomeMy WebLinkAboutGilroy Elks Lodge - Insurance Certificate1 a A`coRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 03/28/2016 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(les) 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 x Eddie Medeiros Insurance agency inc 5701 Lonetree Blvd Ste 109 Rocklin CA 95765 CA Lic#OH87113 CON TA M CT NA E: Eddie I iC N.9 E). 916- 626 -6300 INC. No): ADDRESS: emedeiros @farmersagent.com INSURERS AFFORDING COVERAGE NAIC # INSURERA: .INSURED Gilroy BPOE 1567 & Elks Hall P.O. Box 488 Gilroy CA 95021 INSURER B : INSURER C: Technology Insurance Company 39071 INSURER D : DAMAGE TO RENTED PREMISES Ea occurrence INSURER E : MED EXP (Any one person) 1 INSURER F: PERSONAL & ADV INJURY f`nvcoAfSCQ f'FRT1PIf_AT1= NI IMRFR• REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 'r0 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. IN SR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MMIDD EFF MMIDD EXP LIMITS - - - GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE E OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY_ PRO LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE. LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON OWNED ,HIRED AUTOS AUTOS COM13IN5D SINGL5 UMIT (Ea accidert) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLALUIB OCCUR EXCESS UAB HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ I $ C WORKERS COMPENSATION AND EMPLOYERS' UABwTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED7 ❑Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A TWC3539025 04/01/2016 '04/01/2017 X I WC STATU- 9TH E.L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYE -- $ 1000000 E . DISEASE - POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Gilroy, its officers, officials, agents, employees and volunteers CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©19$82010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE*CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. _ AUTHORIZED REPRESENTATIVE Gilroy CA 95020 - - - ACORD 25 (2010/05) ©19$82010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 4_CtRD,v CERTIFICATE OF _LIABILITY INSURANCE Date (MM/DDIYYY`n 3/30/2016 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 endorsemen s . PRODUCER Aon's Affinity Insurance Services, Inc. The Elks Insurance Program 200 E Randolph, 4th Floor CONTACT A,Dawney PHONED, (A/C, No, Ext): 800) 421 -3557 FAX (A/C, No): (312) 381 -2751 POLICY EXP MM/DDIYYYY LIMITS Chicago, IL 60601 INSURER S' AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: EACH Benevolent and Protective Order of Elks of U.S.A INSURER C: Gilroy CA Lodge # 1567 P.O. Box 488 Gilroy, CA 95021 INSURER D: INSURER E: INSURER F: OCCURRENCE r_nVFRAr.FS CERTIFICATE NUMBER: 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 OF THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7351 Rosanna Street INSR LTR TYPE' OF INSURANCE POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS © 1988 -2009 ACORD CORPORATION. All rights reserved.. GENERAL LIABILITY EACH $ 1,000,000 OCCURRENCE PERSON & ADV INJURY $ 1,000,000 • X COMMERCIAL GENERAL LIABILITY MV11ZY 307217 03/31/16 03/31/17 CLAIMS OCCUR GENERAL $ 1,000,000 MADE AGGREGATE PRODUCTS- $ 1,000,000 COMP /OPP AGG AGGREGATE LIMIT GEN'L APPLIES PER: OCCUR AUTOMOBILE LIABILITY COMBINED $1,000,000 • X I HIRED AUTOS MWZY 307217 03/31/16 03/31/17 SINGLE LIMIT (Ea accident) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Insured Lodge: Gilroy CA Lodge # 1567 Date: THE CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED AS RESPECTS THE INSURED'S OPERATIONS DURING THE DESCRIBED EVENT OR ACTIVITY NOTED ABOVE. HIRED AND NON -OWNED AUTO COVERAGE IS SUBJECT TO THE GENERAL AGGREGAT E COVERAGE DOES NOT INCLUDE LIQUOR LIABILITY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 -6197 AUTHORIZED REPRESENTATIVE © 1988 -2009 ACORD CORPORATION. All rights reserved.. ACORD 25 (2010/05) 1 The ACORD name and logo are registered marks of ACORD