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Home My WebLink AboutINS CERT 2009-06-29AC40R" ® DATE (MM/DD/YYYY) k CERTIFICATE OF LIABILITY INSURANCE 6/9/2009 PRODUCER (415) 978-3800 FAX: (415) 978-3825 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Calender-Robinson Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FB02 67 0 63 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 300 Montgomery St., Suite 888 San Francisco CA 94104 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Great American Insurance CorStone INSURER B: Tower Select Insurance 33 Buchanan Drive INSURER C: INSURER D: ,Sausalito CA 94965 INSURER E: cnVFRAr.Fs 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 POLICY EFFECTIVE POLICY EXPIRATION TR ~D TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD /Y Y DATE (MM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 000' 000 1' A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR IPAC 7575606 03 3/19/2009 - - DAMAGE TO RENTED PREMISES (Ea occurrence~__ 100, 000 3/19/2010 MED EXP (Any one person) $ 5-'apo - PERSONAL & ADV INJURY $ -1 1000,000 - - GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: i - 1 PRODUCTS= COMP/OP AGG $ 2 000,000 POLICY PRO- LOC JECT l l I AUT - - OMOBILE LIABILITY COMBINED SINGLE LIMIT E i 000 000 $ 1 ANY AUTO a acc dent) ( , , A - ALL OWNED AUTOS PAC 7575606 03 3/19/2009 3/19/2010 , BODILY INJURY SCHEDULED AUTOS (Per person) $ X X f HIRED AUTOS NON-OWNED AUTOS !(Ij It~S C f - BODILY INJURY Per accident ~ ) $ ( - JUN x009 U N PROPERTY DAMAGE $ P id t J ( er acc en ) GA RAGE LIABILITY AUTO ONLY - EA ACCIDENT $ TOWN CL RK - - ANY AUTO TOWN OF TI L1RON EA ACC OTHER THAN $ AUTO ONLY: AGG _ $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR l CLAIMS MADE AGGREGATE - $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION ' X WC STATU- 1OTH- TORY LIMIT LER S AND EMPLOYERS LIABILITY Y / N _L-- _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1c0001000 EXCLUDED a /M E ) M ndao ry n NH TSIWD70808346 01 3/20/2009 3/20/2010 E.L. DISEASE - EA EMPLOYEE $ 1, 0001 000 - - If yes, describe under - - SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is included as additional insured as per the attached endorsement - NOTE: 10 days notice of cancellation for non-payment of premium "("l L el 2( 1 CERTIFICATE HOLDER Town of Tiburon & its agents Attn: Diane Lacopi 1505 Tiburon Blvd. Tiburon, CA 94920 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 Rff R ENTATIVES. n ORIZED REPRESENTATIVE 11 ACORD 25 (2009/01) © 1988-2009 A ORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are regis red marks of ACORD POLICY NUMBER: PAC7575606 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 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. A