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Home My WebLink Aboutdoc01018620140616142042rn2w.uw.0 Accw hM CERTIFICATE OF LIABILITY INSURANCE D 06/10 DO/zo 14 sno 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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. N SUBROGATION IS WAIVED, subject to the temis and Conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the cartificate holder in lieu of such andomement(s). PRODUCER 0726293 1- 415 -546 -9300 Arthur T. Gallagher 6 Co. Insurance Brokers of California, Inc., License 110726293 One Market Plaza, Speer Toper Suite 200 CONTACT NAME. PHONE FAX uc Na: EMAIL ADDRESS: GENERAL LIABILITY X San Francisco, CA 94105 INSURER(S) AFFORDING COVERAGE HNC• INSURERA: AMERICAN ALT INS CORP 19720 Loann Le INSURED INSURERS: Tiburon FED INSURERC: $ 1,000,000 INSURER D: $ 5,000 1679 Tito DO Boulevard INSURER E: Tiburon, CA 94920 INSURER F: 1 1,000,000 COVERAGES CERTIFICATE NUMBER: 40153819 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 LTn TYPEOFINSURANCE ADDL Use POLICY NUMBER POLICY EFF "UDo POLICY EXP MMI MYRS A GENERAL LIABILITY X VPIS -TA- 0022468 -10 07101/1 07/01/14 EACHOCCURRENCE S 1,000,000 X COMMERCUu GENERALLUUNLITY CIAIMEMADE IT] OCCUR DAMAGE TO RENTED PREMISES oc .W $ 1,000,000 MED EXP kw maperm) $ 5,000 A $0 SILS PERSONAL4ADVIWURY 1 1,000,000 GENERAL AGGREGATE $2,000,000 GENLAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMWOP AGO $2.000,000 xi POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaacddanl BODILY IWURY(PW perm) $ ANY AUTO BODILYIWURY(Perac M) S ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE WatuMnl S NON -0WNED HIRED AUTOS AUTOS S UMBRELLALNB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS MADE BED I I RETENTIONS $ WORKERS COMPENSATION WCSTATU- OTH- FR ANOEYPLOYERS'UABIUTY YIN ANY PROPRIETORFARTNERIEXECUmIE E.L. EACH ACCIDENT $ OFFICENMEMBEREXCLUDEDI 0 NIA E.L DISEASE- EA EMPLOYE $ (Mandatory In NH) I /yyes,de WuNw DESCRIPTION OF OPERATIONSMN E.L. DISEASE - POLICY LIMIT S DESCNPDONOFOPERARONSILOCAnONSIVEHICLES (AINCh ACOR0101, AddIINnM Ramalka SaM4uN,Hmdn aWUle nputra4) RR: Sidewalk CPR (CPR Booth) on 06/14/14 ADDITICNAL INSMUM(S) : Town of Tiburon, its agents, officials and employees. The above listed policy shall be primary any insurance carried by the Additional Insured shall be non- contributory. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of Tiburon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Tiburon Blvd AUTHORQED REPRESENTATIVE on, CA 94920 USA Z 19118.2010 ACORO CORPORATION. All rtahts reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD rgreen 40153819 k O ry 0 o° m W Pnb(1UEWx,E Policy Number: vyxs- TA- 0022468 -10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: GENERAL LIABILITY COVERAGE PART Name of person or organization: Town of Tiburon, its agents, officials and employees [If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.] SECTION II. WHO IS AN INSURED is amended to include as an insured the person or organization shown above, but only with respect to liability arising out of your operations or premises owned by or rented to you. VGL300 (03/03) Copyright 2002 American Alternative Insurance Carporation. All Page 1 of 1 rights reserved. Includes copyrighted material of the Insurance GENERAL LIABILITY services Office, Inc. voth its permission. I Yi 11AX13MIX 11 Arthur J. Gallagher & Co. 1255 Battery Street #450 San Francisco, CA 941 1 1 Electronic Service Requested MIXED AADC 945 8[140 0.5234 MB 0.432 IIIlluhr4lrllhlhrlrllurulrrlllrr6hlhlllrlhlllllllldrl Town of Tiburon 202 1505 TIBURON BLVD TIBURON, CA 94920 -2530 i3 EBIX BPO This document was brought to you by Ebix /CertificatesNow and Arthur S. Gallagher & Co. Insurance Brokers of California, Inc. in San Francisco, CA. - Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate.- - If you have questions regarding the content of this document, please contact - the Producer /Agent listed on the certificate of insurance.- The data included in this notice and in the attached document is confidential to - Ebix /CertificateeNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc.- cc: - Heidi Rosevear Tiburon FPD (EMAIL) The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertlikatesNow - www.ConfimNetxom - 877.669.8600 WR tic 0 z w