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HomeMy WebLinkAboutdoc03571820160329162039e 12/22/2015 11:13 AM Applied Systems, Inc 4415-435-2438 G)1 ACOR1J CERTIFICATE OF LIABILITY INSURANCE ) DATE(MMIDDIYYYY) 12/22/2015 THIS -k IS D AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES I1NOT ��AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.INS TTKric6TE C F I AND AHNCE E CERTIFICATE NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED OLDER. IMP• : p , i holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the • I' L' Ali•• a� •n•L�I` _ •policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certifica'' • • �I i `t+ .' L oh endorsement(s). PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of CA. 1255 BatteryStreet #450 License #0726293 San Franciso CA 94111 CONTACT NAME: PHONE 415-546-9300 FAX 415-536-8499 !Arc Na FXt1 IAIO, Not: E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAICP INSURERA:Church Mutual Insurance Company 18767 INSURED ROMACAT-17 Roman Catholic Archbishop of San Francisco One Peter Yorke Way San Francisco, CA 94109 INSURER s :Underwriters at Lloyd's London 15792 INSURER C Old Republic Union Insurance Compan 31143 INSURER D : $1,000,000 INSURER E : S50,000 INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 1051986688 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 TYPE OF INSURANCE INSD WVO POLICY NUMBER POLICY EFF (MMfOD/YYYYI POUCY EXP IMMIDDIYYYY) LIMITS B C x COMMERCIAL GENERAL LIABILITY Y PK1026315 8215000626689 7/1/2015 7!112015 7/1/2016 7/1/2016 EACH OCCURRENCE $1,000,000 DAMAGE 1U REN I EU PREMISES (Ea occurrence) S50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $6,000 PERSONAL 8 ADV INJURY 51;000.000 GENERAL AGGREGATE $2.000000 GEN'L AGGREGATE POLICY OTHER' LIMIT APPLIES PE�X J PER' LOC PRODUCTS .COMPATPAGG $2,000,000 S B C7!112015 AUTOMOBILE X LIABILITY ANY AUTO AUTOWNED HIRED AUTOS — — SCHEDULED NON.OWNED AUTOS PK1026315 8215000626689 7/1/2015 7/112016 7!112016 LUM iNtU SINt,Lt LIMIT (Ea accident) 5 1000000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S NHOI'ERIY DAMAGE (Per accident) S UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE 5 AGGREGATE $ S DED RETENTION S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNERIEXEOJTIVE❑NIA IM OFFICEREM BER E(CLU DED7 (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below 050005507860966 1/1/2016 11112017 X PERTAUTE 0TH ER E.L. EACH ACCI DENT 51.000.000 E.L. DISEASE • EA EMPLOYEE 51,000,000 EL. DISEASE . POLICY LIMIT 51,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more apace is required) Certificate Holder is listed as additional insured on the General Liability per the attached endorsement RE: St. Hilary School, 765 Hilary Dr, Belvedere Tiburon, CA 94920. As respects Annual Field Day being held at St. Hilary School on June 05, 2015. Town of Tiburon and their officers, agents and employees are listed as Additional Insured only where contract requires per attached . PRIMARY: It is understood and agreed that this insurance is primary and any other insurance maintained by the additional insured shall be excess only and non contributing with this insurance. CERTIFICATE HOLDER CANCELLATION I Town of Tiburon and their officers, agents and employees Public Works Dept., 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 POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE jf M ACORD 25 (2014101) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD O 12/22/2015 11:13 AM Applied Systems. Inc > 415-435-2438 a 2 ENDORSEMENT attaching to and forming part of Policy No. PK1026315 NAMED ASSURED: Roman Catholic Archbishop of San Francisco, A Corp. Sole Effective date of this endorsement: July 01, 2015 Endorsement No. 7 CERTIFICATES OF INSURANCE It is hereby understood and agreed that holders of Certificates of Insurance issued against this Policy that are shown as Additional ASSU REDS are added to this Policy pursuant to the terms of this Policy as described in GENERAL POLICY DEFINITION 1. Where Certificates of Insurance are requested for Additional ASSUREDS who do not fall within GENERAL POLICY DEFINITION 1, prior agreement of Underwriters and subsequent endorsement of this Policy is required. GENERAL POLICY DEFINITION 1. ASSURED is stated as follows - 1. ASSURED means not only the NAMED ASSURED as stated on the Declaration Page, but also includes any past, present or future: agencies, subsidiaries, affiliates, institutions and societies owned by or operated by the NAMED ASSURED, officials, members of boards or commissions, trustees, directors, officers, partners, volunteers, student teachers, or employees of the NAMED ASSURED while acting within the scope of their duties as such, and any person, organization, trustee or estate to whom the NAMED ASSURED is obligated by virtue of a written contract or agreement to provide insurance such as is offered by this policy, but only in respect of operations by or on behalf of the NAMED ASSURED. Except as amended in this Endorsement, this insurance is subject to all coverage terms, clauses and conditions in the policy to which this Endorsement is attached. Page 1 of 1