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Home My WebLink About2010-11-01 (Marin Horizon School)From: Jeannie Hatalsky At: Suhr Risk Services FaxID: Suhr Risk Services To: Diane Crane Lacopi Date: 9/152010 11:08 AM Page: 1 of 4 Suhr Risk Services License 0610521 5300 Stevens Creek Blvd San Jose, CA 95129 Phone: 408.510.5440 FAX: 408.510.5490 Website: www.insuhr.com DATE: 9/15/2010 11:08:45 AM FAX: (415) 435-2438 TO: Town of Tiburon ATTENTION: Diane Crane Lacopi FROM: Jeannie DIRECT: (408) 510-5440 TOTAL NUMBER OF PAGES WITH COVER SHEET: 4 SUBJECT: Child Development, Inc. - Certificate of Insurance RE: Hi Diane, Attached, please find the requested certificate of insurance for the above captioned policyholder. Should you have any questions, please feel free to contact me directly at 408.510.5456. Thank you. Have a. great day! Jeannie CONFIDENTIAL NOTE: Information in his facsimile is confidential and intended for use by the individual or entity named above. If you received this telecopy in error, please immediately telephone us and return the original via U.S. Postal Service. From: Jeannie Hatalsky At: Suhr Risk Services FaxID: Suhr Risk Services To: Diane Crane Lacopi Date: 9/152010 11:08 AM Page: 2 of 4 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID ID 15 DATE (MM/DD/YVYV) ~ 8 09/15/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Suhr Risk Services HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 5300 Stevens Creek Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Jose CA 95129 Phone:408-510-5440 Fax:408-510-5490 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER. A: Hartford Pir• Insurance Co. INSURER 8: Hartford casualty insurance Co AttnThe: Anna Shubea hubea Horizon u SCh001 INSURERC ComPwest Insurance Co. 305 Montford Avenue CA 94941 Mill Valle INSURER D: y, INSURER E: COVERAGES 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. INUK LTR AUU-N NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/OO/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY 57UUNIO5995 11/01/09 11/01/10 PREMIS ES (Ea occurence) .'t j U KEN _u $ 300 , 000 I CLAIMS MADE Fx I OCCUR MED E.KP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Educators Legal 57UUNI05995 11/01/09 11/01/10 GENERAL AGGREGATE $ 2,000,000 GEtd'L AGGREGATE LIMIT A DPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY JECT LOC Emp Ben. Included AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B X A14YAUTO 57UUNIO5995 11/01/09 11/01/10 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) R PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER. THAN EA ACC $ AUTO ONLY AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 B X OCCUR F -1 CLAIMS MADE 57RHUUP9108 11/01/09 11/01/10 AGGREGATE $ 10f000,000 DEDUCTIBLE $ X RETENTION $10,000 $ WORKERS COMPENSATION AND X TORY LIMITS ER C EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXE :UTIVE CA005004312002 07/01/10 07/01/11 E1, EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E L. DISEASE - EA EMPLOYEE $1,000,000 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 named as additional insured as per attached endorsement form CG2026. *10 days notice of cancellation for non-payment of premium. RE: 14th Annual MHS Invitational X-Country event for 3,4,5 grade students - October 13, 2010 CERTIFICATE FIC)LDFR CANCELLATION TOWNOFT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 * DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO $O SHALL Town of Tiburon IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 1505 Tiburon Blvd Tiburon CA 94920 REPRESENTATIVES. AU ZED REPRE NTAT • ACORD 25 (2001/08) U AGOKO GOKPOKATION 1998 From: Jeannie Hatalsky At: Suhr Risk Services FaAD: Suhr Risk Services To: Diane Crane Lacopi Date: 9/152010 11:08 AM Page: 3 of 4 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 (2001108) From: Jeannie Hatalsky At: Suhr Risk Services FaxID: Suhr Risk Services To: Diane Crane Lacopi Date: 9/15/2010 11:08 AM Page: 4 of 4 POLICY NUMBER: 57UUN105995 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement mo, iifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Additional Insured Person(s) or Organization(s): The Mosaic Project, Enchanted Hills Camp, United Camps, Conferences, and retreats, their members, directors, officers, employees, agents, and independent contractors Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II -Who Is An Insured is amended to in- include as an additional insured the person(s) or or- organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or missions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you.