HomeMy WebLinkAboutINS CERT 2009-05-2305-16-2000 11:41am From-MINTO AND WILKIE 4154950526 T-465 P.001/003 F-276
FAX COVER SHEET
MINTO A WILKIE INSURANCE AGENCY, INC.
PO BOX 150990 / 1235 FOURTH STREET
SAN RAFAEL, CA 94915-0980
License No. 0093447
FAX NO: 415-435-2438
FAX TO: Diane
Town of Tiburon
DATE: May 18, 2009
NO. OF PAGES: 3
(INCLUDING COVER)
D E C E V F
MAY 1 8 2000 Pi
TOWN CLERK
TOWN OF TIBURON
RE: Tiburon Salmon Institute
Please attached the certificate of ins nce listing the Town of Tiburon as an additional
insured. Ple t me know it you ire additional information.
Thank you,
FROM: Natale Dulick, ext 40
PHONE 415.453-0610 FAX 415-485-0528
This fax is intended for the use of the individual or entity to which it is addressed, and may contain information that is
pnvilege4, confidential and exempt from disclosure uncler applicable law. If you nave received this communication in
error, please notify us immediately by collect telephone call and return the original fax to us at the above address by
US mail. We will reimoume you for your postage.
05-18-2008 11:41 am From-MI NTO AND WILKIE 4154850528 T-465 P.002/003 F-276
•+AJ~ %,r-R iri%oAI C Ur I,lAC11t.1 I Y INSURANCE zP10 N DATE (NwDDlYY1/n
25/16109
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Xtnto i Mxlki• Insurance MOWER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
RO son 150990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
San Rafael CIL 94915-0990
Phone: 415'-453-0610 Fait : 415-485-0528 INSURERS AFFORDING COVERAG9 NAIC If
IN61►REp INSURER A. NonProl&Cs Insaranvr wil3anar
INSURER S. State C 9atlon Fund
TA.buron $jIlmon Institute INSURER C.
Tiburon CA . 94 920 INSURER D
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED 13ELOW 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 wITM RESPECT TO wMICH ThIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN. TnE INSURANCE AFFORDED BY TOE POLICIES DESCAIBED 1IEREP% Is SuRiECT TO AI.L THE TERMS. OtCLUSIONs AW CONDITIONS OF Such
POLICIES AGGREGATE wWTS SnOwN MAY HAVE BM REDUCED BY PAID C~A►MS
)kwA TYPE OF iMWRAWE I POLICY NUMBER I o w It&W, I' N"WII "
GENML LIADILRY
A X COMMERCIAL GENERAL LIABILITY 2008-23312-NPO 05/22/09 05/22/1C
CLAIMS MADE XX OCCUR
GEN'L AGCREGATE wmiT APPLIES PER-
P0 41Cr ,A- mac
AUTOMOBILE LYOWIY
A AMY AUTO 2008-23312-'>IM 05/22/09 05/22/10
ALL OWNED AUTOS
X 5CMEDULED AUTOS
X MRED AUTOS
NO"W NED AUTOS
GARAGE LoSiLM
-
ANY AUTO
EXCeSaUalsRE6N► U ABILITY
OCCUR M CLAIMS MADE
H DEOuCTIBLE
RETENTION S
WORKERS COMPEN811T1011 AW
H EMPLOV993'UA&NTY 567-1202-08 06/23/09 06/23/10
ANY PROPRIETOMPARTNEWFxECUTIVE
OFFFIICEWMEMPAR EXCLUDED?
11 y
SPECIAL PRCV19 NS wow
DEECRIPTIDN OF OPEAATION4 I LOCATIONS I YlHICLE91 EXCLUSION ADDEO IIr EI100Ri9WI(T / BPECIAL PROVISIONS
Certificate holder is named addstional insured per attacheld CG2011
portaina to the event being held on 5/23/09.
TE
Town of T*buron
1505 Tibur*A Blvd.
Tiburon G 94920
LIWTS
EACH OCCURRENCE
1 10000 00
PREMISES Ee w4wrenoa
$100000
MEDExP(Any anA Anwn)
$ 10000
PERSONAL A AOV INJURY
$1000000
GENERAL AGGREGATE
S1000000
PRODUCTS-COMPiOPAGG
S2000000
CO&ONED SINGLE LIMB
(EA awawn)
$1000000
BODILY INJuRV
S
(Pw yrreon)
BODILY InuURY
;
(Per iCGaw)
PROPERTY DAMAGE
:
(Pa SmOSAI)
AUTO ONLY - EA AMOENT
S
OTKA THAN EA ACC
S
AUTO ONLY' AGG
S
F-ACn OCCuRRENCE
S
AGGREGATE
_
S
i
TORY IIAITS ERA
E.L. EACH ACCIDENT
; 3-1000 000
E.I. DISEASE - EA EMPLOY
:
El DMASE-POLICY LIMIT
$
as it
TOWO-1 6"0060 ANY OF THE ABOVE OF-WRAID POLICIES RE CANCIELLED BEFORE THE EXPIRATIOi
PATE THEREOF, THE NSUING IN9aRER m" eNDEAvOR TO MAIL 30 DAYS WRITTEN
NOtIC9 TO TII! CERTIFICAT! M X9KR NAMED TO THE LEFT. OUT FAILURE TO DO SO S►IALL
NPIM NO ONLIwTION OR L4MLITY of ANr KIND UPON THE INiuRER. ITS AGEWS OR
AEPPA39NTATWLS.
IJeftrey S- Allan Ext. 30
Acoao sa (2001101)
19"
05-18-2009 11:41am From-MINTO AND WILKIE 4154650528 T-465 P.003/003 F-276
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR LESSORS OF
PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART. -
SCHEDULE
Name of Person or Organization (Additional Insured). Town of Tiburon
1505 Tiburon Blvd
Tiburon, CA 84820
(if no entry appears above, the information required to complete this endorsement will be shown in the Declara-
tions as applicable to this endorsement.)
WHO is INSURED (Section II) is amended to indwoo
as an insured the person or organization shown in the
1. Any "occurrence" which takes place after you
Schedule out only with respect to liability arising out of
cease to be a tenant in that promises.
the ownership, maintenance or use of that pan of the
premises leased to you and shown in the Scnedule
2. Structural alterations, new construction or dem-
and subject to the following additional exclusions:
oliuon operations performed by or on behalf of
the person or organization shown in the Scneaule.
This insurance does not apply to,
CG 2011 1185 Copyright. insurance jervices Office. Inc., 1984