The URL can be used to link to this page

Home My WebLink AboutINS CERT 2008 r I ACORD", .&./".......,:.......I.....D..>........I1....:.;........,..i ....tV,:.;: :" '.:) .;:: -";i::::~;: :< ;"-," .', .-",.--...,-"":" -". "";':'-:'.. ,: ,.-::, ...... .^..... '" .... -''''.,',-,',._" Mid-Century Insurance, THIS /S EVIDENCE THAT INSURANCE AS IDENT/FIED BELOW HAS BEEN ISSUED, IS IN FORCE AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY. ' .;' PRODUCER PHONflFAX '. AIe,No Ex!: 415-454-0100415-454_831 COMPANY Michael Miller Insurance 817 Mission Avenue San Rafael CA 94901 R. Michael Miller CODE: SUB CODE: ~3~~8~ER 10 N: PTTI B-1 INSURED Pt. Tiburon Marsh HOA Mifssingham & Associates 2247 National Avenue Hayward CA 94545 EFFECTIVE DATE 60249-60-62 EXPIRATION DATE lOAN NUMBER POUCY NUMBER 09/30/07 09/30/08 THIS REPLACES PRIOR EVIDENCE DATED: CONTINUED UNTIL X TERMINATED IF CHECKED PROPERTVIHFORMAtJON LOCA TION/DESCRIPTION 001 7 Marsh Road Tiburon CA 94920 UNIT OWNER: COVERAGE/PERllS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE BLANKET BUILDING COVERAGE WITH EXTENDED REPLACEMENT COST BUSINESS PERSONAL PROPERTY BUILDING ORDINANCE: CONTINGENT LIABILITY DEMOLITION INCREASED COST OF CONSTRUCTION GENERAL LIABILITY: $3,000,000 PER OCCURRENCE $5,000,000 AGGREGATE CRIME-EMPLOYEE DISHONESTY (FIDELITY BOND) $500,000 5,153,000 14,100 5,153,000 128,600 642,900 5,000 REMARKS CANCELLATION THE POLICY IS SUBJECT TO THE PREMIUMS, FORMS, AND RULES IN EFFECT FOR EACH POLICY PERIOD. SHOULD THE POLICY BE TERMINATED, THE COMPANY WILL GIVE THE ADDITIONAL INTEREST IDENTIFIED BELOW 30 DAYS WRITTEN NOTICE, AND WILL SEND NOTIFICATION OF ANY CHANGES TO THE POLICY THAT WOULD AFFECT THAT INTEREST, IN ACCORDANCE WITH THE POLICY PROVISIONS OR AS REQUIRED BY LAW. ADDITIONALINTI!RSST NAME AND ADDRESS **Proof of Insurance** AUTHORIZED REPRESENTATIVE ;:' . ft. ("'"'-w " .F..' Jf.A , /... ~~"'."~'01f:4f~~;~ ,.OACORDCORPOAATION 1993 I ACORD 27 (3193) R. Michael Miller ACORD CERTIFICA TE O~ LIABILITY INSURANCE I DATE TM 12/20/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ferrante Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE HOLDER. THIS CERTIFICA TE DOES NOT AMEND, EXTEND OR 3018 Willow Pass Road AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 INSURERS AFFORDING COVERAGE Concord CA 94519- INSURED INSURER A: Lloyds of London 5151 Ken Soldavini Custom Painting INSURER B: PO Box 900 INSURER C: INSURER D: Ross CA 94957- 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS lTR DATE (MM/DDIYY) DATE IMM/DDIYY) A GENERAL LIABILITY MCP 04 002031 12/13/2007 12/13/2008 EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ 100,000 I CLAIMS MADE [i] OCCUR / / / / MED EXP (Anyone person) $ 5,000 - PERSONAL & ADV INJURY $ 1,000,000 ~ / / / / GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT nES PER: PRODUCTS - COMP/OP AGG $ 1,000,000 rxl n PRO- / / / / POLICY JECT LOC ~UTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ t-- ALL OWNED AUTOS / / / / BODILY INJURY t-- t-- SCHEDULED AUTOS (Per person) $ - HIRED AUTOS / / / / BODILY INJURY - NON-OWNED AUTOS (Per accident) $ - / / / / PROPERTY DAMAGE (Per accident) $ ~RAGE UA81LITY AUTO ONLY - EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS liABiliTY / / / / EACH OCCURRENCE $ :J OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND / / / / I WC STATU- I IOTH- EMPLOYERS' liABILITY TORY LIMITS ER ~l.. EACH ACCIDENT $ / / / / E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER / / / / DESCRIPTION OF OPERA TlONS/lOCA TlONSNEHIClES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate holder is to be named as additional insured. CERTIFICA TE HOLDER I I ADDITIONAL INSURED; INSURER lETTER: CANCELLA TION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ( ) - (415) 435-2438 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE lEFT, BUT - City of Tiburon FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR liABILITY OF ANY KIND UPON THE Tiburon Police Department INSURER, ITS AGENTS OR REPRESENTATIVES. 1505 Tiburon Blvd. AUTHORIZED REPRESENTATIVE D r:2 Tiburon CA 94920- - ACORD 25-S (7/97) f'ieTM- INS025S (9910).02 ELECTRONIC LASER FORMS, INC. - (800)327-0545 @ ACORD CORPORATION 1988 Page 1 of 2 POLICY NUMBER: MCP 04 002031 COMMERCIAL GENERAL LIABILITY MCP 1031 0807 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Town of Tiburon; Tiburon Police Department 1505 Tiburon Blvd. Tiburon , CA 94920 RE: Repainting Wood Handrails @ Various Locations (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. It is further agreed that this insurance shall be primary and noncontributory but only in the event of the Named Insured's sole negligence. MCP 1031 0807 Page 1 of 1 o MARSH CERTIFICATE OF INSI .~ANCE CERTIFICATE NUMBER CLE-001345448-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTt:r< OF INFORMATION ONLY AND CONFERS MARSH USA INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE TWO LOGAN SQUARE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AlTER THE COVERAGE PHILADELPHIA, PA 19103-2797 AFFORDED BY THE POLICIES DESCRIBED HEREIN. Attn: Comcast.Certs@marsh.com Fax: 212-948-0360 COMPANIES AFFORDING COVERAGE COMPANY b5194 -ALL-GAWU-07-08 COMC SAN CA A DISCOVER PROPERTY & CASUALTY INSURANCE COMPANY -- INSURED COMPANY COMCAST OF MARIN I, INC. , B ACE PROPERTY & CASUALTY INS CO 12647 ALCOSTA BLVD., STE 200 P.O. BOX 5147 COMPANY SAN RAMON, CA 94583 C FIDELITY & GUARANTY INS. CO. COMPANY D N/A COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted . below. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS lTR DATE (MM/DDIYV) DATE (MMIDDIYV) I GENERAL LIABILITY GENERAL AGGREGATE 1$ 25,000,000 ~ 1------ A X COMMERCIAL GENERAL LIABILITY DOO 1 QOO048 12/01/07 12/01/08 PRODUCTS - COMP/OP AGG $ 6,000,000 I CLAIMS MADE II] OCCUR PERSONAL & ADV INJURY $ 4,900,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 4,900,000 - FIRE DAMAGE (Anyone fire) $ 4,9~~ I--- X $100,000 SIR MED EXP (Anv one oerson) $ 10,000 AUTOMOBilE LIABILITY $ 10,000,000 I--- COMBINED SINGLE LIMIT A X ANY AUTO D001A00340 (AOS) 12/01/07 12/01/08 I--- A ALL OWNED AUTOS D001A00341 (MA) 12/01/07 12/01/08 BODILY INJURY $ I--- A SCHEDULED AUTOS D001A00342 (TX) 12/01/07 12/01/08 (Per person) ~ ~ HIRED AUTOS BODIL Y INJURY $ (Per accident) .- NON-OWNED AUTOS ~ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ I--- ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ I--- AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 5,000,000 B ~ UMBREllA FORM XOO G23792254 12/01/07 12/01/08 AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND I WCSTATU~- EMPLOYERS' LIABILITY X TORY L1M~TS E~_ ~. C D001W00403 (AOS) 12/01/07 12/01/08 EL EACH ACCIDENT $ 2,000,000 C THE PROPRIETOR! ~INCL D001W00404 (OR,WI) 12/01/07 12/01/08 EL DISEASE-POLICY LIMIT $ 2,OOO,-~ PARTNERS/EXECUTIVE A OFFICERS ARE: i i EXCL D001W00405 (NJ) 12/01/07 12/01/08 EL DISEASE-EACH EMPLOYEE $ 2,000,000 OTHER I I DESCRIPTION OF OPERATlONS/LOCATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. $100,000 PER OCCURENCE SELF INSURED RETENTION APPLIES ONLY TO THE ABOVE GENERAL LIABILITY POLICY, CERTIFICATE HOLDER .. CANCELLATION . SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, RECeIVED THE INSURER AFFORDING COVERAGE VlnLL ENDEAVOR TO MAIL ---3.Q DAYS WRITTEN NOTICE TO THE TOWN OF TIBURON CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR A TTN: TOWN MANAGER DEe 1 9 2007 1155 TIBURON BLVD. LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. ITS AGENTS OR REPRESENTATIVES, OR THE TIBURON, CA 94920 ISSUER OF THIS CERTIFICATE TOWN MANAGERS OFFICE MARSH USA INC. ~~fn~'t '3 ad ~~. '~1..--<----d~<'- TOWN OF T/BURON BY: Mary Radaszewski MM1 (3/02) VAUD AS OF: 12/13/07 MARSH CERTIFICATE OFINSI'QANCE PRODUCER MARSH USA INC. TWO LOGAN SQUARE PHILADELPHIA, PA 19103-2797 Attn: ComcastCerts@marsh.com Fax: 212-948-0360 CERTIFICATE NUMBER CLE-001345442-10 THIS CERTIFICATE IS ISSUED AS A MATTI:" OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR AlTER THE COVERAGE AFFORDED BY THE POUCIES DESCRIBED HEREIN. 05194 -ALL-GAWU-07-08 -. INSURED I .--~-I I COMPANIES AFFORDING COVERAGE COMC SAN CA COMPANY A DISCOVER PROPERTY & CASUALTY INSURANCE COMPANY -- COMCAST OF CALIFORNIA V, INC. 12647 ALCOSTA BLVD" STE 200 P.O, BOX 5147 SAN RAMON, CA 94583 COMPANY B ACE PROPERTY & CASUALTY INS CO COMPANY C FIDELITY & GUARANTY INS, CO, COMPANY D N/A COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE (MMIDD/YV) DATE (MM/DDIYY) TYPE OF INSURANCE A GENERAL LIABILITY __. X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE ~ OCCUR __ OWNER'S & CONTRACTOR'S PROT 12/01/07 i 12/01/08 I DOO 1 000048 I X $100.000 SIR AUTOMOBilE LIABILITY A A A '--- X '--- 112/01/08 12/01/08 12/01/08 D001A00340 (AOS) D001A00341 (MA) D001A00342 (TX) ANY AUTO ALL OWNED AUTOS 12/01/07 12/01/07 12/01/07 f----- _ SCHEDULED AUTOS _ HIRED AUTOS -- NON-OWNED AUTOS - GARAGE LIABILITY - f--..- ANY AUTO I-- EXCESS LIABILITY B !Xl UMBRELLA FORM ---I OTHER THAN UMBRELLA FORM I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C D001W00403 (AOS) C Ii ~~~:NREO~~~~~~~T1VE 1Xl1NCL D001W00404 (OR,WI) A ,OFFICERS ,A,RE: lIexCL D001W00405 (NJ) OTHER XOO G23792254 [12/01/07 12/01/08 12/01/07 12/01/07 12/01/07 12/01/08 12/01/08 12/01/08 I I LIMITS GEN~RALAGGRFGATE r~.RODUCTS' cqMP/OP AGG L.PERSONAL & ADV INJURY ~H OCCURRENCE ~~MAGE (Anyone fire) MED EXP (Anv one person) COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (per accident) PROPERTY DAMAGE AUTO ONLY. EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ AGGREGATE $ $ 1 WC STATU. I I OEJT~H. X TORY LIMITS I ~ ~L EACH ACCIDENT $ ! EL DISEASE-POLICY LIMIT I $ IEL DISEASE.EACh EMPLOYEE! $ 1$ $ $ $ $ $ $ 25,000,000 -- 6,000,000 4,900,000 4,900,000 4,900,000 10,000 10,000,000 $ $ $ 5,000,00~ 5,000,000 2,000,000 2,000,000 2,000,000 DESCRIPTION OF OPERATlONS/lOCATIONSNEHICLES/SPECIAL. ITEMS CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED AS RESPECTS THE GENERAL LIABILITY POLICY WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. $100,000 PER OCCURENCE SELF INSURED RETENTION APPLIES ONLY TO THE ABOVE GENERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION TOWN OF TIBURON ATTN: TOWN MANAGER 1155 TIBURON BLVD, TIBURON, CA 94920 RECEIVED DEe 1 9 2007 SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WLL ENDEAVOR TO MAIL ---30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR L1ABILrry OF ANY KIND UPON THE INSURER AFFORDING COVERAGE. rrs AGENTS OR REPRESENTATIVES, OR THE TOWN MANAGERS OFFICE ISSUEROFTHISCERTIFICATE TOWN OF TIBURON MARSH USA INC, BY: Mary Radaszewski MMt(3/02) -~h1~tJ adU~0'---d~<-" VAUD AS OF: 12/13/07 ACORD CERTIFICATE OF- LIABiliTY INSURANCE I DATE (MM/DD/YYYY) TM. 12/11/2007 PRODUCER Phone: (360) 598-3700 Fax: (360) 598-3703 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MICHAEL J. HALL & COMPANY RPG ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AlE INSURANCE SERVICES HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 19578 10TH AVENUE N.E. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POULSBO WA 98370 INSURERS AFFORDING COVERAGE NAIC# Aaencv liC#: 91-1461089 INSURED INSURER A: LLOYD'S OF LONDON THE PHILLIPS GROUP -- INSURER B: FIDELITY & GUARANTY INS CO 100 STONY POINT ROAD # 290 INSURER C: U S FIDELITY & GUARANTY CO. SANTA ROSA, CA 95401 INSURER D: 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, INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC DATE IMM/DDNYI DATE (MM/DDNYI GENERAL LIABILITY BK02177527 12/15/06 12/15/07 EACH OCCURRENCE $ 1,000,000 f--- DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ 300,000 I CLAIMS MADE IXl OCCUR I MED. EXP (Anyone person) $ 10>O~~ cl I--- --' ~ PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 '--- GEN'L AGGREGATE LIMIT APPLIES PER i PRODUCTS-COMP/OP AGG, $ 2,000,000 n n PRO- nLOC POLICY JECT AUTOMOBILE LIABILITY BA02175739 12/15/06 12/15/07 COMBINED SINGLE LIMIT -- $ 1,000,000 X ANY AUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY - (Per person) $ SCHEDULED AUTOS B - HIRED AUTOS BODIL Y INJURY I--- $ NON-OWNED AUTOS (Per accident) f--- -- I--- PROPERTY DAMAGE $ I (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY BK02177527 12/15/06 12/15/07 EACH OCCURRENCE $ 1,000,000 o OCCUR D CLAIMS MADE AGGREGATE $ 1,000,000 C $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I we STATU- I I OTHER TORY LIMITS EMPLOYERS' LIABILITY AN"'" "'f<O;:'RiE:TCRi?A~TNC::~,''':X!.:CUT~\..2 I I ~~ ACCIDEN~__t-!-__________ OFFICER/MEMBER EXCLUDED? I E.L. DISEASE-Ej~. EMPLOYEE i $ If yes, describe under EL DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER 1138899825/007 02/25/07 12/15/07 $1,000,000 EACH CLAIM A PROFESSIONAL LIABILITY $1,000,000 AGGREGATE CLAIMS MADE FORM RETRO: FEBRUARY 1, 1978 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Re: Town of Tiburon Building Inspection Town of Tiburon is an additional insured per written contract or agreement between insured and insured's client on the Commercial General Liability and Automobile Liability Policies as respects liability arising out of activities by or on behalf of the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Tiburon EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE 1505 Tiburon Blvd TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. Tiburon CA 94920 IT'S AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE ~hle:r.Hul~ Attention: Dean Bloomquist ACORD 25 (2001/08) Certificate # 67824 @ ACORD CORPORATION 1988 POLICY NUMBER: BK02177527 COMMERv,AL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED (Section II) is amended to include any person or organization that you agree in a "contract or agreement requiring insurance" to include as an additional insured on this Cover- age Part, but: 2. Only with respect to liabi!ity for "bodily injury", "property damage" or "personal injury"; and b. If the injury or damage arises out of the per- formance, by you or your subcontractor, of "your work" to which the "contract or agree- ment requiring insurance" applies. Such per- son or organization does not qualify as an additional insured with respect to their inde- pendent acts or for "bodily injury", "property damage" or "personal injury" for which that person or organization has assumed liability in a contract or agreement. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a. This insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. b. This insurance does not apply to the render- ing of or faiiure to render any "professional services" . c. The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed to provide in that "contract or agree- ment requiring insurance", or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. 3. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non-contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance". But this insur- ance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured is an additional insured under any other insurance. 4. The following is added to Paragraph 8. Transfer of Rights of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDI- TIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance with such person or organization entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. 5. As respects the insurance provided to the addi- tional insured by this endorsement, the following definition is added to DEFINITIONS (Section V): CG D3 81 0906 @ 2006, The St Paul Travelers Insurance Companies, Inc. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 COMMERCIAL GENERAL LIABILITY "contract or agreement requIring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreements in effect; and c. Before the end of the policy period. All other terms of your policy remain the same. Page 2 of 2 @ 2006, The St Paul Travelers Insurance Companies, Inc. Includes copyrighted material of insurance Services Office, Inc., with its permission CG 03 82 09 06 o ACORDTM CERTIFICATE 0.- LIABILITY INSURANCE I DATE (MM/DDIYYYY) 1/11/2008 PRODUCER License # OB23506 (858) 541-2900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Vanorsdale Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4909 Murphy Canyon Road, Suite 510 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Diego, CA 92123 INSURERS AFFORDING COVERAGE NAIC# INSURED NBS Government Finance Group INSURER A: Maryland Casualty Insurance Company 32605 Highway 79 South, Suite 100 INSURER B: AmerJcan States Insurance Company Temecula, CA 92592 INSURER c: Republic Indemnity INSURER D: INSURER E: NBSGOVE-01 SBB 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. INSR IAmj'L --- -- ----- - -- Pt?l-+~~~~~68LWr Pgk!fEYI~~~t~~N -- ---- L TR ~NSRn TYPE OF ' . ..~- POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,00000~ A X PASOO053837 9/24/2007 9/24/2008 DAMA\jE TO RENTED $ 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) I CLAIMS MADE 0 OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 - 4,000,000 GENERAL AGGREGATE $ I-- 4,000,00~ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ M POLICY n ~fRT nLOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 ,OOO,OO~ I-- $ B X ANY AUTO 01 CH0603343 2/13/2008 2/13/2009 (Ea accident) I-- ALL OWNED AUTOS BODILY INJURY f----- $ SCHEDULED AUTOS (Per person) I-- HIRED AUTOS BODILY INJURY - (Per accident) $ NON-OWNED AUTOS - - PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ~ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ :=J OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE - ------ ~---_._- $ RETENTION $ $ WORKERS COMPENSATION AND X I WC STATU- I IOTH- TORY LIMITS ER C EMPLOYERS' LIABILITY 17355501 9/24/2007 9/24/2008 1 ,OOO,OO~ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E,L, DISEASE - EA EMPLOYEE $ 1 ,OOO,OO~ If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1 ,OOO,OO~ SPECIAL PROVISIONS below OTHER - ---.- - I I, \ECFIVED I, DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS .' I JAN 1 4 2008 ] *Except 10 days notice of cancellation for non-payment of premium. Proof of Insurance r; : , i 'l"'~] ENT . i. '. TOv~'{\v j"'IIBURON I CERTIFICATE HOLDER CANCELLATION Town of Tiburon Attn: Ms. Heidi McVeigh 1505 Tiburon Blvd Tiburon, CA 94920- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3~ 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 - - -', ~_ "---'.-----=-__;l.Z-~.~'V<'>-.j..;?-' --;--'>c.=/'L...e.e.;;/_:7) @ACORD CORPORATION 1988 ACORD 25 (2001/08)