HomeMy WebLinkAboutINS CERT 2008-04-01
A CORDTM CERTIFICA TE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
3/26/2008
PRODUCEfl. (415)788-9810 FAX: (415)248-3534 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ISU/San Francisco ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
201 California St. , Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License # 0778092
San Francisco CA 94111-5098 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Travelers
Belvedere-Tiburon peninsula Chamber of INSURER B:
Georgia Kirchmaier INSURER c:
P.O. Box 563 INSURER D:
Tiburon CA 94920 INSURER E:
:l
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.
I~~: ~~~~ TYPE OF INSURANCE POLICY NUMBER PJ>.H~~~:~68tWf Pgk!fJ,~~~~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
I--- ~~~~~~J?E~~~~~nce\
X COMMERCIAL GENERAL LIABILITY $ 300,000
A I CLAIMS MADE ~ OCCUR X6607525B455TIL08 4/1/2008 4/1/2009 MED EXP (Anv one oerson\ $ 10,000
- PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-
-il'L AGGREnE LIMIT AFlES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY ~~i LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY $
(Per person)
- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY $
(Per accident)
I-- NON-OWNED AUTOS
I--- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO \ EA ACC $
OTHER THAN
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY _.~. . ~~~. ICC~"It"~ $
~ OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION !t $
WORKERS COMPENSATION AND I TVX~~T ~JI~~ I OJ~-
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $
If yes. describe under E. L DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS respects to Liability as required by
Certificate Holder, Its Agents and Employees, is named as Additional Insured as
written contract only as pertains to Insured's operations as per Form GN 0188.
CERTIFICA T
(415)435-2438 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Town of Tiburon EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Attn: Diane Crane Iacopi 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
-
1505 Tiburon Boulevard FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Tiburon, CA 94920 INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE .-
Jason Cheung/JASONC -=-
I 1988
E HOLDER
CANCELLA TION
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORA T ON
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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 (2001/08)
INS025 (0108).OBa
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