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HomeMy WebLinkAboutSKMBT_C35113040813050Client#: 24287 SHREIT ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/29/2013 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 CONTACT NAME: Amber Chavin Chicago Commercial Lines PHONE FAX ac, No, Ext : 312 279-4638 A/C, No : 866 714-2419 HUB International Midwest Limited E-MAIL SS: amber.chavin@hubinternational.com 55 East Jackson Boulevard INSURER(S) AFFORDING COVERAGE NAIC # Chicago, IL 60604 INSURER A : Continental Insurance Company 35289 INSURED Sh d i INSURER B : Zurich Insurance Company re - t USA Inc Sh INSURER C : New Hampshire Insurance Co. 23841 red-it Concord 5159 C INSURER D National Union Fire Insurance 19445 ommercial Cr, Ste A C d CA INSURER E oncor , 94520-8582 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 CONTRACTOR 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY 2098337614 04/01/2013 04/01 /201 EACH OCCURRENCE $11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $200,000 CLAIMS-MADE 7 OCCUR MED EXP (Any one person) $15,000 PERSONAL & ADV INJURY $1,000 000 GENERAL AGGREGATE , $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO JECT X LOC $ D AUT OMOBILE LIABILITY CA9203569 4/01/2013 04/01/201 COMBINED SINGLE LIMIT Ea accident 2 000 000 X ANY AUTO BODILY INJURY (Per person) , , $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY Per accident) ( ) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ B X UMBRELLA LIAB X OCCUR 8840945 4/01/2013 04/01/201 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5 000 000 DED X RETENTION $10,000 , , $ C WORKERS COMPENSATION 039901107 4/01/2013 04/01 /201 X WC STATU- 0TH- AND EMPLOYERS' LIABILITY 1 ER Y / N ANY PROP RIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If E.L. DISEASE - EA EMPLOYEE $1,000,000 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The certificate holder is an Additional Insured under the General Liability coverage in accordance with form CG2026 0704, Additional Insured Designated Person or Organization. Y\ ~ 4 ,P 8' P d J VGR I Irl~.rh l C nv~ucR _ GANGELLATIDN Town of Tiburon 1505 Tiburon Blvd. Tiburon, CA 94920 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S706838/M706721 DEM