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HomeMy WebLinkAbout2010-11 Marin Center for Independent LivingACS °r CERTIFICATE OF LIABILITY INSURANCE 12~7i2oio Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 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). PRODUCER CONTACT NAME: Katherine Berkman Calender-Robinson Company, Inc. A( /CNNo Ext) 415) 978-3800 (A/C, No): (415) 978-3825 FB02 67 0 63 E-MAIL ADDRESS: kberkman@ calrob. com 300 Montgomery St., Suite 888 00000054 CUS TOMER PRODUCER ID#: San Francisco CA 94104 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A .NOnprof its ' Insurance Alliance INSURER B :North American Elite Insurance Marin Center for Independent Living _ INSURER c 710 - 4th Street - - - INSURER D : INSURER E : San Rafael CA 94901 INSURER F COVERAGES CERTIFICATE NUMBER:CL107703942 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - - - - - jADDL1SUBRi POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I R D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY i LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X CO COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED PREMISES (Eaoccurrence) _ _ $ 500,000 7/22/2010 7/22/2011 A CLAIMS MADE X OCCUR 2010-08626-NPO 1 MED EXP (Any one person) 20 , 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 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 000 000 $ 1 , , (Ea accident) ANY AUTO i I 1 2010-08626-NPO 7/22/2010 17/22/2011 _ - - _ BODILY INJURY (Per person) $ A ALL OWNED AUTOS - _ _ - - - BODILY INJURY (Per accident) $ SCHEDULED AUTOS 1 PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS - $ _ UMBRELLA LIAB OCCUR 1 ACH OCCURRENCE $ EXCESS LIAB 1 CLAIMS-MADE - AGGREGATE - $ r - - DEDUCTIBLE ~~ee, k IA $ - V RETENTION $ V CIO $ WORKERS COMPENSATION WC STATU- 0TH-, LIABILITY YERS' Y/N TOWN CLE O TORY LIMITS ER Rl PRIETOR/PA ANY ❑ RTNER/ ANFlC PRO RPM EMBER E RTNER/ UDED? EXECUTIVE N / A TOWN OF TIBUR E.L. EACH ACCIDENT $ pN (Mandatory in NH) $ E.L. - - DISEASE - EA EMPLOYEE' ~ yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT B Employee Dishonesty Cws 0001321 17/22/2010 7/22/2011 Each claim $ 100 , 000 Deductible $ 500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Use of Tiburon Town Hall for presentation on 1/25/2011 Certificate holder is included as additional insured as per the attached endorsement - NOTE: 10 days notice of cancellation for non-payment of premium Insurance provided under the additional insured is primary & non-contributory to any other valid & collectible insurance carried by certificate holder CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Tiburon & its agents ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Tiburon Town Clerk 1505 Tiburon Blvd. AUTHORI DREPRESENTATIVE Tiburon, CA 94920 - ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD 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 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy, and for which a certificate of insurance naming that person or organization as additional insured has been issued. 3. Additional Premium: INCLUDED (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule CG 20 11 01 96