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Home My WebLink AboutSKMBT_C35113042510240870 ACOREP CERTIFICATE OF LIABILITY INSURANCE " DATE(MM/ Y) 2013 03/ 1 9/2013 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 MARSH USA INC NAME: . 20 CHURCH STREET PHONE FAX A/C No Ext : A/C No : HARTFORD, CT 06103 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :Hartford Fire Insurance Company 19682 INSURED CARRIER CORPORATION - INSURER B :National Union Fire Insurance Company of Pittsburgh, PA 19445 ONE CARRIER PLACE INSURER C :New Hampshire Insurance Company 23841 FARMINGTON, CT 06034-4015 k:1, INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:RA9BDYJX RFV141nNI NIIMRFR- 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. I~TR TYPE OF INSURANCE AIN R WVD POLICY NUMBER MM/DDY/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 02CSET10004 04/01/2013 04/01/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY $2,000,000 general a re ate er PRDAMAGE TO RENTED EMISES Ea occurrence $ 300,000 CLAIMS-MADE ~ OCCUR gg g $ policy 110,000,000 p ) MED EXP (Any one person) $ 10,000 general aggregate PERSONAL & ADV INJURY 1,000,000 $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY PRO- F7] LOC $ A AUT OMOBILE LIABILITY 02CSET10000 (A/O) 04/01/2013 04/01/2014 COMBINED SINGLE LIMIT 02CSET10019(HI) Ea accident $ 1,000,000 X ANY AUTO Hartford Underwriters Ins BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR 02HUT10021 04/01/2013 04/01/2014 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ B WORKERS COMPENSATION 636195 1 ( L I 5 04/01/2013 04/01/2014 X RY iM T O R C AND EMPLO ERS' L ABILITY CA-033 57 5360 F -0 35 36 T Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ N / A NJ-033575362 MULTI-033575363 MULTI-033575364 MA-033575365 E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If MN-033575366 MULTI-033575367 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 yes, describe under DESCRIPTION OF OPERATIONS below PA-033575368 MULTI-033575369 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Tiburon Town Hall and PD, 1505 Tiburon Boulevard, Tiburon, CA 94920 e/The Town of Tiburon and its employees and agents are additional insured for general liability, but only with respect to liability arising out of Carrier Corporation's work for the additional insured. The general and automobile liability policies are primary and non-contributory to any maintained by or available to the additional insured. A waiver of subrogation is granted in favor of the additional insured with respect to workers' compensation as required by written contract. Severability of interest is included in the general liability. 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 AUTHORIZED REPRESENTATIVE 1505 Tiburon Boulevard ,r:J Tiburon, CA 94920 1'7) Page 1 of 1 U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD