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HomeMy WebLinkAboutdoc00992720140610172956A � °® CERTIFICATE OF LIABILITY INSURANCE i1/18�2013' 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 endorsement(s). PRODUCER ISU SF SD Intl - Consolidated 201 California St., Suite 200 License # 0778092 San Francisco CA 94111 -5098 CONTACT Jason Cheun NAME: g PHONE (415) 788 -9810 FAX No), (415)248-3534 EMAIL .jcheung @isugroup. com INSURERS AFFORDING COVERAGE NAICis INSURER A:Travelers LIMITS INSURED Belvedere- Tiburon Peninsula Chamber of Commerce P.O. Box 563 Tiburon CA 94920 INSURER B AUTHORIZED REPRESENTATIVE INSURER C: Tiburon, CA 94920 INSURER D: INSURER E: S 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:13 -14 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 LTR TYPE OF INSURANCE JIM SUER POLICY NUMBER MMIDDYIYYYY MM ODf EXP LIMITS Attn: GENERAL LIABILITY AUTHORIZED REPRESENTATIVE 1505 Tiburon Boulevard Tiburon, CA 94920 RRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY RENTED a occunence) S 300,000 A CLAIMS -MADE �X OCCUR 6607525H455TIL13 /1/2013 /1/2014 y one person) S 10,000 ADV INJURY RGENER�IL $ 1,000,000 X Liquor Liability GREGATE S 2 , 000 , 000 GENL AGGREGATE LIMIT APPLIES PER' - COMP /OP AGG $ 2,000,000 S X POLICY PRO LOG JFQT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) S BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) S ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per a..,d t S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS LIAR CLAIMS-MADE DED I I RETENTIONS I S WORKERS COMPENSATION VdC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ECUTIVE❑ E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT S It yes, desaiW_ under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space Is required) RE:Holiday Festival - December 7, 2013 Town of Tiburon, its Agents, Officials, and Employees are Named Additional Insureds as respects to Liability as required by written contract only as pertains to Insured's operations as per Form GN 0188. Coverage is Primary & Non - Contributory as per Form CGD037. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010105) INS025 (201005).011 ©1988 -2010 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Tiburon Attn: Diane Crane Iacopi AUTHORIZED REPRESENTATIVE 1505 Tiburon Boulevard Tiburon, CA 94920 Jason Cheung ACORD 25 (2010105) INS025 (201005).011 ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: X -660- 75258455- T1L -13 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 02 -05 -13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHARITY FIRST - AMENDMENT OF COVERAGE- WHO IS AN INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization (Additional Insured): Town of Tiburon, its agents, officials and employees 1505 Tiburon Boulevard Tiburon, CA 94920 Designation Of Premises (Part Leased to You) Any Town of Tiburon -owned properties used by the insured by its events. WHO IS AN INSURED (Section 11) is amended to include as an insured: A. Your members and volunteers but only with respect to their liability for your activities or ac- tivities they perform on your behalf; S. Your trustees or members of the board of gover- nors while acting within the scope of their duties as such on your behalf; and C. Person(s) or organization(s), whether or not shown in the Schedule above, but only with respect to their liability arising out of: 1. Their financial control over you; 2. Their requirements for certain performance placed upon you, as a non- profit organize- tion, in consideration for funding or financial contributions you receive from them; 3. The ownership, maintenance or use of that part of a premises leased to you; or 4. "Your work' for that insured by or for you. As respects Part C.3. above, this insurance does not apply to: (a) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organiza- tion(s); or (b) Any "occurrence" which takes place after you cease to be a tenant in that premises. GN 01 88 01 96 Copyright, Travelers Indemnity Company. Page 1 of 1 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of 1