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HomeMy WebLinkAbout2011-03-15 (Bipolar Advantage)BAYRISK INSURANCE BROKERS, INC/PHS PO BOX 33015 SAN ANTONIO TX, 78265 The Town of Tiburon c/o Diane Crane Iacopi Tiburon Town Hall Council Chambers room 1505 TIBURON BLVD TIBURON, CA 94920 ACORD 25 (2009/09) A,TTI ® CERTIFICATE OF LIABILITY INSURANCE R001 DATE (MM/DD/YYYY) 05-17-2011 THIS CERTIFICATEIS 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 SUBROGATIONIS 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: BAYRISK INSURANCE BROKERS, INC/PHS PHONE FAX No Extl: (866)467-8730 (A/c,No): (877) 905-0457 M 101275 P:(866)467-8730 F:(877)905-0457 PO BOX 33015 AI E- ADDRESS: SAN ANTONIO TX 7 8 2 6 5 PRODUCER CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC INSURED INSURER A : Sentinel Iris CO LTD INSURER B BIPOLAR ADVANTAGE INC PO BOX INSURER C 923 BELVEDERE TIBURON CA 94920 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE DDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 0 0 0 0 0 0 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 , 000, 000 A CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 10,000 X General Liab x 57 SBA ZF5283 03/15/2011 03/15/2012 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2, 000, 000 ID PRO- POLICY Lam' LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000, 000 ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ A X SCHEDULED AUTOS 57 SBA ZF5283 03/15/2011 03/15/2012 PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEI---~ OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT $ LJ (Mandatory in NH) E.L. DISEASE EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Those usual to the Insured's Operations. Event RE: Monday, June 20, 2011 7:00 p.m. - 8:30 p.m.Tiburon Town Hall. Town of Tiburon is named as an additional insured for the use of Town property, and that the insurance is primary and non-contributory per business liability coverage form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION The Town of Tiburon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED c/o Diane Crane Iacopi BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE Tiburon Town Hall Council Chambers room DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1505 T I BURON BLVD AUTHORIZED REPRESENTATIVE T I B URON , CA 9 4 9 2 0 QZGz © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD