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HomeMy WebLinkAbout2011-12 Leukemia/Lymphoma SocietyCERTIFICATE OF LIABILITY INSURANCE /YYYY) DATE(MM/D82 oaro Oil 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 AOn Risk Services N rth t I NAME: o eas , nc. Parsippany NJ Office PHONE (866) 283-7122 (A/c. No. Ext): ac. No.: C847) 953-5390 10 Lanidex Center West E-MAIL P.O. BOX 608 ADDRESS: Parsippany NJ 07054-0608 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia Indemnity Ins Co 18058 The Leukemia & Lymphoma Society, Inc. 1311 Mamaroneck Avenue suite 310 INSURER B: , white Plains NY 10605 USA INSURER C: INSURER D: INSURER E: INSURER F: U_ co C7 `m m .O d .a O 2 %+UVtKAGCS GtKIII-IGAIt NUMBER: 51UU41113Z 4b 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDNYYYl MIDD/YYYY M LIMITS A GENERAL LIABILITY PHPIC EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY RENTED DAMAGE T $1 000 000 P REM SE Ea occurrence , , CLAIMS-MADE Fx] OCCUR MED EXP (Any one person) $20,000 PERSONAL & ADV INJURY $1,000,000 Ln GENERAL AGGREGATE $3,000,000 N GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000 v PRO- X POLICY JECT LOC CD o t` AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Lo Ea accident ANY AUTO BODILY INJURY (Per person) z ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) d a+ HIRED AUTOS NON OWNED PROPERTY DAMAGE v AUTOS Per accident w d UMBRELLA LIAB H OCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND WC STATU OTH- EMPLOYERS' LIABILITY Y I N TORY LIMITS R ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. EACH ACCIDENT (Mandatory in NH) If es describe under E.L. DISEASE-EA EMPLOYEE , DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Regarding Event: Team Training. Town of Tiburon and Its Agents are included as Additional insured as required by written N contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability policy. General Liability coverge evidenced herein is Primary and Non-Contributory to other insurance available to the certificate Holder, but only to the extent required by written contract with the Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Tiburon and its Agents AUTHORIZED REPRESENTATIVE Attn: Diane Crane Iacopi -y 1805 Tiburon Blvd. Tiburon CA 94920 USA t_WL" Mwal5a;"t7 c/1Ozxaull J L ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD INSURED The Leukemia & Lymphoma society, Inc. 1311 Mamaroneck Avenue, Suite 310 white Plains NY 10605 USA CG2026 - Additional Insured Endorsement POLICY NUMBER: PHPK702673 POLICY DATES: 03/30/11 to 03/30/12 PHILADELPHIA INDEMNITY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED--DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) See CERTIFICATE DESCRIPTION. 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. CG 20 26 Insurance services office, Inc., Certificate No : 570042123245 Enclosed please find the requested certificate for your event. We have released the holder original to the holder, via mail, as designated on the certificate, with a copy to The Society's Corporate Offices, as well as your chapter. Should you have any questions, or require further assistance with this certificate, please contact Kathy Aiello, at Corporate Offices, the Leukemia & Lymphoma Society, Inc. Thank you. The Leukemia & Lymphoma Society Attn: Kathy Aiello The Leukemia & Lymphoma Society 1311 Mamaroneck Avenue White Plains, NY 10605 Office Phone: 914-821-8867 Office Fax: 914-821-8937 Kathryn.Aiello@lls.org