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Home My WebLink AboutSKMBT_C35113041713240® 1A4C7"'!2D CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/17/2013 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 A i k i h NAME: on R s Serv ces Nort east, Inc. PHONE FAX Morristown NJ office (866) 283-7122 (847) 953-5390 (A/C. No. Ext): (A/C. No. : 44 Whippany Road, Suite 220 E-MAIL Morristown NJ 07960 USA ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia Indemnity Ins co 18058 The Leukemia & Lymphoma society, Inc. 1311 Mamaroneck Avenue Suite 310 INSURER B: , white Plains NY 10605 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570049657435 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY PHPK EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO REWreF P REMISES Ea occurrence $1, 000, 000 CLAIMS-MADE a OCCUR MED EXP (Any one person) $20,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $3,000,000 X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. EACH ACCIDENT (Mandatory in NH) If describe under es E.L. DISEASE-EA EMPLOYEE y , 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) Re arding Event: Team Training. Town of Tiburon and its Agents are included as Additional insured in accordance with the policy provisions of the General Liability policy. General Liability coverage evidenced herein is Primary and Non-Contributory to other insurance available to Town of Tiburon and its Agents, but only in accordance with the policy's provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Tiburon and its Agents AUTHORIZED REPRESENTATIVE Attn: Diane crane Iacopi 1505 Tiburon Blvd. Tiburon CA 94920 USA ©1988-2010 ACORD CORPORATION. All rights reserved. L_ a d L d 0 2 O Z d M V d U NA W Ete ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD