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HomeMy WebLinkAbout2010-11 Chamber of Commerce (2)ACORD~, CERTIFICATE OF LIABILITY INSURANCE 4DATE /30/2010 Y) PRODUCER (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: P.O. BOX 563 INSURER C: INSURER D: Tiburon CA 94920 INSURER E: OVERAGES 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 T TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIYY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ 300 , 000 A CLAIMS MADE a OCCUR X6607525B455TIL10 4/1/2010 4/1/2011 MED EXP An one 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 PRO- X POLICY JECT LOC AUT OMOBILE 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) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1 OCCUR F~ CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND ' WC STATU- OTH- TORY LIMITS ER EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Certificate Holder, Its Agents and Employees, is named as Additional Insured as respects to Liability as required by written contract only as pertains to Insured's operations as per Form GN 0188. CERTIFICATE HOLDER CANCELLATION (415)435-2438 Town of Tiburon Attn: Diane Crane Iacopi 1505 Tiburon Boulevard Tiburon, CA 94920 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jason Cheung/JASONC ACORD 25 (2001/08) INS025 (0108).08a © ACORD CORPORATION 1988 Page 1 of 2 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).08a Page 2 of 2 POLICY NUMBER: X6607525B455TIL10 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 04 - 01- 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CHARITY FIRST-AMENDMENT OF COVERAGE- WHO IS AN INSURED 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 Boulevard Tiburon, CA 94920 Designation Of Premises (Part Leased to You) WHO IS AN INSURED (Section II) is amended to include as an insured: A. Your members and volunteers but only with respect to their liability for your activities or ac- tivities they perform on your behalf; B. Your trustees or members of the board of gover- nors while acting within the scope of their duties as such on your behalf; and C. Person(s) or organization(s), whether or not shown in the Schedule above, but only with respect to their liability arising out of: 1. Their financial control over you; 2. Their requirements for certain performance placed upon you, as a non-profit organiza- tion, in consideration for funding or financial contributions you receive from them; 3. The ownership, maintenance or use of that part of a premises leased to you; or 4. "Your work" for that insured by or for you. As respects Part C.3. above, this insurance does not apply to: (a) Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organiza- tion(s); or (b) Any "occurrence" which takes place after you cease to be a tenant in that premises. GN 01 88 01 96 Copyright, Travelers Indemnity Company. Page 1 of 1