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Home My WebLink AboutSKMBT_C3511301141636012/24/2012 10:46:53 AM -0700 FAXCOM Commercial Lines - (973) 437-2300 Wells Fargo Insurance Services USA, Inc. 7 Giralda Farms, 2nd Floor Madison, NJ 07940-1027 To : Town Of Tiburon From: Marcia Samples (404-823-1327) Fax : 415-435-2438 Subject: Certificate Of Insurance on behalf of (Girl Scouts of Northern California ) PAGE 2 OF 4 Comments: This is your requested certificate of insurance. CID: NORTCAL1, SID: 5349732 This certificate was sent to you using CyberSure, Wells Fargo Insurance Service's client portal. This message may contain confidential and/or privileged information If you are riot the addressee or authorized to receive this for the addressee, you must not use, copy, disclose, or take any action based on this message or any information herein. If you have received this message in error, please advise the sender immediately by reply fax and delete this message Thank you for your cooperation 12/24/2012 10:46:53 AM -0700 FAXCOM PAGE 3 OF 4 NORTCAL 1 A r CERTIFICATE OF LIABILITY INSURANCE DA Y) 12/24/20112 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: Commercial Lines - (973) 437-2300 PHONE FAX NC No Ext : (A/C, No): Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: 7 Giralda Farms, 2nd Floor INSURER(S) AFFORDING COVERAGE NAIC # Madison, NJ 07940-1027 INSURER A : Travelers Property Casualty Co of America 25674 INSURED INSURER B : Girl Scouts of Northern California INSURER C 7700 Edgewater Drive, Suite 340 INSURER D : INSURER E : Oakland, CA 94621 0149 INSURER F : V11 M\i1VYY 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 INSR WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY 66087721-816 01/01/13 01/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENED P REMISES Ea occur ence $ 1,000,000 CLAIMS-MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1 000 000 , , GENERAL AGGREGATE 000 000 $ 5 , , GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 2,000,000 POLICY E O LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO ALL OWNED BODILY INJURY (Per person) $ AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A EL EACH ACCIDENT $ (Mandatory in NH) If yes 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) The Town Of Tiburon is named additional insured on the general liability policy per form CGD3660710 with respect to the use of its premises for Girl Scout activities of the insured Girl Scout Council. Insurance is primary and non-contributory per the wording on the policy. Insurance includes and endorsement providing the town, its agents, officials and employees primary and non-contributory for claims losses etc arisin , , , . g from the exercise of the permit. CERTIFICATE HOLDER CANCELLATION Town Of Tiburon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn: Joan THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1505 Tiburon Blvd Tiburon, CA 94920 AUTHORIZED REPRESENTATIVE I nc Mt URU name ana rogo are reglsterea marKS OTAGUKU U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 12/24/2012 10:46:53 AM -0700 FAXCOM PAGE 4 OF 4 6608772L816 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE -ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance), is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written con- tract or written agreement that the insurance pro- vided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non-contributory basis, this insur- ance is primary to other insurance that is avail- able to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that: a. The "bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an of- fense committed subsequent to the signing and execution of that contract or agreement by you. 2. The first Subparagraph (2) of Paragraph b. Ex- cess Insurance regarding any other primary in- surance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Copyright 2005 The St. Paul Travelers Companies, Inc. All rights reserved. Page 1 of ,