HomeMy WebLinkAbout2010-07-24 Scott Hannahs
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NO. DR (2010/2011)
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY GROUP INSURANCE TRUST, A RISK PURCHASING GROUP
FACILITY OWNER (Additional Insured):
PRODUCER: CA License #0757776
HUB INTERNATIONAL INSURANCE SERVICES INC.
Town of Tiburon
P.O. BOX 4047
CONCORD, CA 94524-4047
PH: 925-609-6500 FX: 925-609-6550
specialevent@hubinternational.com
EVENT HOLDER (Named Insured/Member):
EVENT INFORMATION
TYPE:
Scott Hannahs
DATE(S):?/24/2010
LOCATION:Tiburon Town Hall
ATTENDANCE: CLASS:
This is to certify that the policies of insurance listed below have been issued to the insured named above for the event date(s) indicated above.
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 b the policies described herein is subject to all the terms, exclusions and conditions of such policies.
Insurers: Insurer A: Colon Insurance Com an
Insurer B: Genesis Indemnity Insurance Company
INSR
LTR
Type of Insurance
Policy Number
Effective
Expiration
Policy Limits
Each Occurrence
$250,000
Damage to Premises Rented to
$250,000
You
A
Primary Commercial
General Liability
AR6360147
1/1/2010
1/1/2011
Medical Payments
$5,000
Personal & Advertising Injury
$250,000
General Aggregate
$1,000,000
Products/Completed
Operations Aggregate
$1,000,000
Each Occurrence
$750,000
Personal & Advertising Injury
$750,000
B
Excess Commercial
General Aggregate
$1,500,000
General Liability
ZXB300938G
1/1/2010
1/1/2011
Damage to Premises Rented to
$250,000
You
Products/Completed
Operations Aggregate
$1,500,000
ZXB300938G
1/1/2010
1/1/2011
Each Occurrence
B
Optional Excess Limits
General Aggregate
COVER
AGE TERMS
The coverage afforded by this insurance is primary and not contributing with any insurance held
Occurrence Form (CG 0001)
by the "ADDITIONAL INSURED", WHEN REQUIRED BY WRITTEN CONTRACT. The limits of
Host Liquor Liability Included
insurance apply separately to each event insured by this policy as if a separate policy of
Full Liquor Liability Included when a separate
insurance has been issued for that event. Who is an insured is amended to include as an
premium has been charged.
additional insured the "Facility Owner - Additional Insured" above and any person or
organization shown in the schedule below. This insurance does not apply to: any "occurrence"
All participants in athletic activities are
which takes
lac
ft
th
t h
ld
p
e a
er
e even
o
er ceases to be a tenant in that premises. This insurance
required to sign Release and Waiver of
li
l
t
"
"
"
app
es on
y
o: an
occurrence
which takes place during the dates indicated under
Event
Liability forms.
Information" above.
COVERAGE EXCLUSIONS (REFER TO POLICY FOR COMPLETE LISTING OF EXCLUSIONS):
-Sexual Abuse & Molestation
Specific Events are excluded from coverage.
-Terrorism
Please see reverse side for list of excluded events.
On behalf of the Risk Purchasing Group and each member, the trustee has declined coverage for the Terrorism Risk Insurance Act (TRIA).
OTHER ADDITIONAL INSUREDS:
Belvedere Tiburon Recreation and its agents
CANCELLATION: Should the above described policy(s) be cancelled before the expiration date thereof, the issuing company will endeavor to mail 30
days written notice to the insured event holder and additional insureds listed.
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
7/20/2010
HUB International Insurance Services Inc., 2300 Clayton Road, Suite #300, Concord, CA 94520