The URL can be used to link to this page

Home My WebLink AboutINS CERT 2007-07-01 A CORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) 8/15/2007 PRODUCER Commercial Lines ... 707-769-2900 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ABD Insurance & Financial Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1039 A N. McDowell Blvd Petaluma, CA 94954 INSURERS AFFORDING COVERAGE NAIC# INSURED Marin Country Day School INSURER A: Zurich-American Insurance 16535 5221 Paradise Drive INSURER B: INSURER C: INSURER D: Corte Madera CA 94925 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. rl"'~D ~nD'l PJ>'}{~19~~68,wIE p~~fJ/~X~~~N LTR NSR[ TYPE OF INSURANCE POLICY NUMBER LIMITS A GENERAL LIABILITY CP0399368902 07/01/2007 07/01/2008 EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 I CLAIMS MADE [8] OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 - GENERAL AGGREGATE $ 2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 "I nPRO- n POLICY JECT LOC ~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) - - ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) - '--- HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) '--- '--- PROPERTY DAMAGE $ (Per accident) RRAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY UMB399369102 07/01/2007 07/01/2008 EACH OCCURRENCE $ 10.000,000 . 0 OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000 $ ~ DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION AND I T~~Jr~~~ I IOJ~- 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: "The Tour" October 21,2007. The Town of Tiburon is named as additional insured under the general liability per the attached endorsement UGL 1175A as respects negligence on the part of the insured during "The Tour" event as scheduled with the city. CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN Town of Tiburon NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Scott Anderson IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Dir. Comm. Development REPRESENTATIVES. 1505 Tiburon Blvd. AUTHORIZED REPRESENTATIVE ~ ~ Tiburon, CA 94920 ACORD 25 (2001/08) 1 of 2 61485 @ ACORD CORPORATION 1988 Thic f'arlifif'"ta ranl"f'ac f'arlifif'"ta1l' ~1 L1L1~ iccllan f'\n A/1 A /?nn7 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-5 (2001/08) 2 of 2 #S915260/M915043 Additional Insured - Automatic - Owners, Lessees Or Contractors - Broad Form @ ZURICH Policy No. EfT. Date of Pol. Exp. Date of Pol. Err. Date of End, Producer Add'1. Prcm Return Prem. CP0399368902 07/01/2007 07/01/2008 07/01/2007 $ S THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. WHO IS AN INSURED (SectJon II) is amended to include as an insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. B. The insurance provided to additional insureds applies only to ''bodily injury", "property damage" or "personal and advertis- ing injury" covered under Section I, Coverage A, BODILY INJURY AND PROPERTY DAMAGE LIABll.JTY and Coverage B, PERSONAL AND ADVERTISING INJURY LIABILITY, but only if: 1. The "bodily injury" or "property damage" results from your negligence; and 2. The "bodily injury", "property damage" or "personal and advertising injury" results directly from: a. Your ongoing operations; or b. "Your work" completed as included in the "products.completed operations hazard", perfonned for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless of the provisions of paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" that results solely from negligence of the addi- tional insured; or Includes copyrighted material of Insurance Services Office, Inc. with Its pennlssion. U-GL-I l7S-A CW (9103) Page 1 of2 2. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: a. The preparing, approving, or failing to prepare or approve maps, shop drawings: opinions, reports, surveys, field orders. change orders or drawings and specifications; and b. Supervisory, inspection, architectural or enaineering activities. E. The additional insured must see to it that: 1. Weare notified as soon as practicable of an "occurrence" or offense that may result in a claim: 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity ofthc claim or .'suit" will promptly be brought against any policy, issued by an- other insurer under which the additional insured also has rights as an insured or additional insured. F. The insurance provided by this endorsement is primary insurance and we win not seck contribution from any other in- surance available to any additional insured person or organization unless the other insurance is provided by a contractor other than you for the same operations and job location. Then we will share with that other insurance by the method de- scnbed in paragraph 4.c. of SECTION IV - COMMERCIAL GENERAL UABILITY CONDmONS. Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as writ- ten. U-GL-117,5-A CW (9103) Page 2 of2