HomeMy WebLinkAboutINS CERT 2006-11-21
ACORD", CERTIFICATE OF LIABILITY INSURANCE OP 10 B~ DATE (MM/DDIYYYY)
GLADW-1 11/21/06
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Sawyer, Cook & Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
550 E. Hospitality Lane, #100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Bernardino CA 92408
Phone: 909-379-6700 Fax:909-379-6900 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hartford Insurance Company 22357
INSURER B: Markel Insurance Company
Gladwell Governmental Services INSURER C:
Diane Gladwell
P.O. Box 62 INSURER D:
Lake Arrowhead CA 92352
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER ~9r'!~1,i~rJ~J!XE P9L~Y(fXPIRAT~N LIMITS
DATE MM/DDIYY
GENERAL LIABILITY EACH OCCURRENCE $ 1000000
-
X COMMERCIAL GENERAL LIABILITY ~~~~~~s (E~~~~~nce) $ 300000
I CLAIMS MADE D OCCUR MED EXP (Anyone person) $ 10000
A X Business Owners 72SBAFT4487 10/31/06 10/31/07 PERSONAL & ADV INJURY $ 1000000
-
GENERAL AGGREGATE $2000000
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2000000
I n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- $1,000,000
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- $
A X SCHEDULED AUTOS 72UECUM8398 09/15/06 09/15/07 (Per person)
-
X HIRED AUTOS BODILY INJURY
- $
X NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
=1 DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I. WI,; ~TATU- I IOTH-
TORY LIMITS ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE: E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $
If yes, describe under E.L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
B Professional Liab. MG822984 10/31/06 10/31/07 Agg/Claim 1,000,000
Ded 2,500
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Town of Tiburon is named as additional insured as their interest may
appear per attached form SS04490593 * 10 days notice of cancellation for
non payment of premium.
Town Of Tiburon
Diane Crane Iacopi
1505 Tiburon Blvd
Tiburon CA 94920
CANCELLATION
TIBURON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL * 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Bob Zentner ~k= Q)r,-\i\O__.
@ ACORD CORPORATION 1988
CERTIFICATE HOLDER
ACORD 25 (2001/08)
.
THIS ENDORSEMENT CHANGES THE POLlCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -DESIGNA TE'D PERSON OR
ORGANIZA TION
This endorsement modifiee insurance provided under the following:
13USINES8 UABIUTY COVERAGE FORM
c. Who is an Insured in the BUSINESS LIABILITY
COVERAGE FORM is IWT1ended 'to include 8S an '
insured the person or orgen\zQtion shown in the
Declarations but onty with'reepect to liability Brising
out of the operations of the nllmed Insured.
F Of 108888 covered under the BUSl NESS LIABILITY
COVERAGE of thia policy this insurance ~ primary
to other valid and ccnectlbie insu ranee wtllctl is
available to the person or organ~ion shown in the
D6elaratiOne as an Additional Insured,
Form S5 04 49 05 93' Printed in U.S.A, (NS)
Copyright, Hartfurd Fire InouranCiO Company, 1993