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HomeMy WebLinkAboutdoc02155720150416105433® .4�Ra CERTIFICATE OF LIABILITY INSURANCE DATE (M M/DD/YYYY) 03/30/2015 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 Aon Risk Services Northeast, Inc. MOrri stown NJ Office 44 Whippany Road, Suite 220 Morristown NJ 07960 USA CONTACT NAME: PHONE (866) 283-7122 FAX 800-363-0105 (AIC. No. Ext): (NC. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED The Leukemia & Lymphoma Society. Inc. 1311 Mamaroneck AVE., Ste. 310 White Plains NY 10605 USA INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURERB: PHPK1313532 INSURER C: 03/30/2016 INSURER D: 51,000,000 INSURER E: INSURER F: CLAIMS -MADE X OCCUR COVERAGES CERTIFICATE NUMBER: 570057175755 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADOL INSD SUER MD POLICY POLICY NUMBER POLICY EFF POUCY EXP IMMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY c/Y(/ ��� PHPK1313532 03/30/2015 03/30/2016 EACH OCCURRENCE 51,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) 5100,000 MED EXP (Any one person) S10,000 PERSONAL & ADV INJURY 51,000,000 GGEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 53,000,000 7. I POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG 53,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS — SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS — NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) — UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY l STATUTE I IOTH ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? Y I N N / A E.L. EACH ACCIDENT (Mandatory in NH) Ir describe E.L. DISEASE -EA EMPLOYEE yes. under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Regarding Event: Team Training. Town of Tiburon and its Agents are included as Additional Insured in accordance with the policy provisions of the General Liability policy. General Liability coverage evidenced herein -is Primary and Non -Contributory to other insurance available to Town of Tiburon and its Agents, but only in accordance with the policy's provisions. CERTIFICATE HOLDER CANCELLATION Holder Identifier : GSF Certificate No ACORD 25 (2014/01) ©1988-2014 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 Ti bUron and its Agents AUTHORIZED REPRESENTATIVE Attn: Diane Crane Iacopi 1505 Tiburon Blvd. Ti buron CA 94920 USA N c`� e na%/aa cCJ�/ c/Y(/ ��� Holder Identifier : GSF Certificate No ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A�DWIE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2015 Y) 03!30/2015 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 endorsements /�D PRODUCER �"���„ !! ���! Aon Risk Services Northeast, Inc. Morristown NJ offi ce 44 Whippany Road, Suite 220 0 6 2015 Morristown NJ 07960 USA �'7 � IUWNAil uIr Y'S OFFICE TOWN OG IarlN CONTACT NAME: PHONE (866) FAX FAX 800-363-0105 (AlC. No. Ext): (NC. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC0 INSURED The Leukemia & Lymphoma Society. Inc. 1311 Mamaroneck Ave., Ste. 310 White Plains NY 10605 USA INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURER B: 03/30/2015 INSURER C: EACH OCCURRENCE INSURER D: INSURER E: INSURER F: X COVERAGES CERTIFICATE NUMBER: 570057173052 REVISION NUMBER: THIS 15 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDU SUER INSDI WVD POLICY NUMBER POLICY EFF (MWODIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERALLIABILITY PHPK1313532 03/30/2015 03/30/2016 EACH OCCURRENCE 51,000,000 CLAIMS -MADE X OCCUR DAMAGE TO REN I ED PREMISES (Ea occurrence) 5100,000 MED EXP (Any one person) 510,000 PERSONAL &ADV INJURY 51,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S3,000,000 POLICY PRO -LOC JECT PRODUCTS - COMP/OP AGG S3,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS_ —SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE OED RETENTION WORKERS COMPENSAT ON AND EMPLOYERS' LIABILITY I STATUTE I EORH ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED, Y / N N I A E.L. EACH ACCIDENT (Mandatory in NH) If descnbe E.L. DISEASE -EA EMPLOYEE yes. under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Regarding Event: Run and Hide the Trail. Town of Tiburon, its agents, officials and employees are included as Additional Insured as required by written contract, but limited to the operations of the Insured under said contract, with respect to the General Liability policy. General Liability coverage evidenced herein is Primary and Non -Contributory to other insurance available to the Additional Insured, but only to the extent required by written contract with the Insured. CERTIFICATE HOLDER CANCELLATION Town of Tiburon 1505 Tiburon Blvd. Tiburon CA 94920 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (� /I �Q c .Q4 �% edk c9ft-z rano � �i crie eJ na Holder Identifier : CG 570057173052 Certificate No ACORD 25 (2014/01) ®1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD