HomeMy WebLinkAboutINS CERT 2009 (Leukemia & Lymphoma)A CORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 04/ 3i2o 9
PRODUCER
Aon Risk Services Northeast, Inc.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
Parsippany N] Office
AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
10 Lani dex center west
CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
P.O. Box 608
Parsi
an
NJ 07054-0608 USA
COVERAGE AFFORDED BY THE POLICIES BELOW.
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INSURERS AFFORDING COVERAGE
#
NAIC
PHONE-(866) 283-7122 FAX-(847) 953-5390
INSURED
INSURER N Philadelphia Indemnity ins co
18058
The Leukemia & Lymphoma society, Inc.
1311 Mamaroneck Avenue
Suite 310
INSURER B:
,
white Plains NY 10605 USA
INSURER C:
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 DESCRI
BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED
INSR
LTR
ADD'
INSR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
DATE(MM\DD\YY)
DATE(MM\DD\YY)
A
ERAL LIABILITY
PHPK402304
03/30/09
03/30/10
EACH OCCURRENCE
$1,000,000
X
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED
$100,000
PREMISES (Ea occurence)
CLAIMS MADE ® OCCUR
MED EXP (Any one person)
$10,000
r
PERSONAL & ADV INJURY
$1
000
000
F
E
,
,
A7
GENERAL AGGREGATE
$3
000
000
'
`
TM
,
,
GEN
L AGGREGATE LIMIT APPLIES PER:
-
-
PRODUCTS -COMP/OP AGG
$3,000,000
❑ POLICY PRO ❑
LOC
APR 1
JECT
AUTOMOBILE LIABILITY
u
COMBINED SINGLE LIMIT
ANY AUTO
T
`
M F TIBU
I
ON
(Ea accident)
ALL
OWNED AUTOS
` 1
,
BODILY INJURY
SCHEDULED AUTOS
(Per person)
HIRED AUTOS
BODILY INJURY
NON OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
H
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY:
AGG
EXCESS /UMBRELLA LIABILITY
EACH OCCURRENCE
❑ OCCUR ❑ CLAIMS MADE
AGGREGATE
H DEDUCTIBLE
RETENTION
WORKERS COMPENSATION AND
C STATUS
[1
Y LIMITS
ITOR
J
OTH-
ER
EMPLOYERS' LIABILITY
AN
E.L. EACH ACCIDENT
Y PROPRIETOR / PARTNER / EXECUTIVE
OFFICER/MEMBER EXCLUDED?
E.L. DISEASE-EA EMPLOYEE
Ifyes, describe under SPECIAL PROVISIONS
E.L. DISEASE-POLICY LIMIT
below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Regarding Event: Team Training. Town of Tibu
ron and its agents are included as Additional Insured as respect
General Liability policy.
i
R
OLIDF
R
CANCELLATION
Town of Tiburon and its Agents
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -
Attn : Diane Crane Iacopl
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
1805 Tiburon Blvd.
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Tiburon 94920 USA
BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY _
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 'Q12.111
INSURED
The Leukemia & Lymphoma society, Inc.
1311 Mamaroneck Avenue, suite 310
White Plains NY 10605 USA
CG2026 - Additional Insured Endorsement
POLICY NUMBER: PHPK402304 POLICY DATES: 03/30/09 to 03/30/10
PHILADELPHIA INDEMNITY INSURANCE COMPANY
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED--DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
(If no entry appears above, information required to complete this endorsement will be shown in
the Declarations as applicable to this endorsement.)
See CERTIFICATE DESCRIPTION.
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the schedule as an insured but only with respect to liability arising out of your
operations or premises owned by or rented to you.
CG 20 26 Insurance Services office, Inc.,
Certificate No : 570033814327
Enclosed please find the requested certificate for your event. We have released the holder
original to the holder, via mail, as designated on the certificate, with a copy to The Society's
Corporate Offices, as well as your chapter.
Should you have any questions, or require further assistance with this certificate, please contact
Kathy Aiello, at Corporate Offices, the Leukemia & Lymphoma Society, Inc. Thank you.
The Leukemia Lymphoma Society
Attn: Kathy Aiello
The Leukemia & Lymphoma Society
1311 Mamaroneck Avenue
White Plains, NY 10605
Office Phone: 914-821-8867
Office Fax: 914-821-8937
Kathryn.Aiello@lls.org