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HomeMy WebLinkAboutSKMBT_C35113031812010DATE CERTIFICATE OF LIABILITY INSURANCE 2/8/2013 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 Cossio Insurance Agency PO Box 188 Simpsonville. SC 29681 (864) 688-0121 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION (PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS'. Jubilee Jumps. Inc P. O. Box 1745 Windsor. CA 95492 Contact Name. Andrea Tevini Phone 7075449040 Fax 7075449046 INC. No Ex0 (AID Nol E-Mail: )ubileejumps@sbcglobal. net INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: US Fire Insurance Company INSURER B'. INSURER C'. INSURER D'. INSURER E COVERAGES CERTIFICATE NUMBER: USP108435 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 CDNTF",CT 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. NOR TYPE OF POLICY ADEL SUER POLICY NUMBER POLICY EFF POLICY ESP LIMITS LTR INSR WVD (MMIDD/YY) (MM/DD/YY) GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR A X GEN'L AGGREGATE LIMIT APPLIES PER X POLICY PROJECT LOG AUTOMOBILE LIABILITY ANY AUTO ALLOWNED - SCHEDULED AUTOS AUTOS HIRED AUTOS NON OWNED AUTOS UMBRELLA LIAB OCCUR EXCESS HIRE CLAIMS -MADE RED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERiMEMBER FXCLUDEny - N/A Mandatory In JUL) If yes. descnbe under DESCRIPTION OF OPERATIONS below A Accident Medicel SRPGP-101-0312 1/2812013 1/2812014 Personal/Advertising Injury Products/Completed Operations Fire Damage Limit - Any One Fire Deductible per Claim Each Occurrence General Aggregate Medical Expenses $1,000,000 $2.000,000 $300,000 $0 $1,000.000 $2000.000 $5,000 COMBINED SINGLE LIMIT $ L. accident) BODILY INJURY $ (Per Person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ (Per accident) WC STATU- OTH- TORY LIMITS ER Maximum Medical Benefit per claim $10.000 Accidental Death/Dismemberment B $10000 US076513 1/28/2013 1/28/2014 Deductible $0. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required) Party Equipment Rentals Operations located at 390 Rohnert Park Expressway Rohnert Park. CA 94928. Certificate Holder As Additional Insured Amusements devices on file with company for special events dated throughout policy period located at various locations, Tiburon, CA. CERTIFICATE HOLDER: CANCELLATION Town of Tiburon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1505 Tiburon Blvd EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Tiburon. CA 94920 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD © 1988-2010 ACORD CORPORATION. All rights reserved.