Loading...
HomeMy WebLinkAboutSKMBT_C35113071513030ACG V CERTIFICATE OF LIABILITY IN RAN E D07 /09lDD/Y/2013 �,- Su C 07/093 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 0726293 1- 415 -546 -9300 CONTACT NAME: Arthur J. Gallagher Co. _ _ _ -� _ >� -_ PHONE FAX Insurance Brokers of Cali o i nc. nse _ 7 9'3" I No, Ext): (AIC, No): One Market Plaza, Spear T w IL Suite 200 D RESS: San Francisco, CA 94105 INSURER(S) AFFORDING COVERAGE NAIC # Loann Le INS RER A: AMERICAN ALT INS CORP 19720 INSURED JUL 1 5 7013 INS RER B: Tiburon FPD INS RER C : 1679 Tiburon Boulevard FINANCE �DEPARTMEN INS RERD: Tiburon, CA 94920 TOVy`N OF TIBURON INS RERE: -� - - -- -- - - -......_.e_ ...r.a_......._._.m.- .....,,.,. INSURER F: COVERAGES rFRTIFIr ATF NIIMRFR• 34698750 RFVICIAKI KIIJURGR• 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 TYPE OF INSURANCE ADDL'SUBR POLICY EFF LTR POLICY NUMBER MM /DDNYYY POLICY EXP LIMITS MMIDDIYYYY A GENERAL LIABILITY X VFIS -TR- 0022468 -10 07/01/13 07/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1`000'000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 X $0 SIR ,PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN`- AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS bOUILY INJURY (Per accident) $ NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (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 E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: Tiburon Triathalon to be held on July 28, 2013 ADDITIONAL INSURED(S): Town of Tiburon CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Tiburon THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1505 Tiburon Blvd AUTHORIZED REPRESENTATIVE Tiburon, CA 94920(G�cl USA ) ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD rgreen 34698750 TIN: CV O N rV z w Arthur J. Gallagher & Co. 1225 Battery Street 4450 San Francisco, CA 941 1 1 Electronic Service Requested 3 -DIGIT 949 22548 0.5234 AT 0.381 III III II III IIiliili�lllii��il�iii1111 11 oil III IIIIIIIIIII1llllii11 Town of Tiburon 96 1505 TIBURON BLVD TIBURON, CA 94920 -2530 EBIX BP* This document was brought to you by Ebix /CertificatesNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. in San Francisco, CA. - Any documents forwarded with the certificate request were reviewed for the sole purpose of completing the certificate. - If you have questions regarding the content of this document, please contact - the Producer /Agent listed on the certificate of insurance. - The data included in this notice and in the attached document is confidential to - Ebix /CertificatesNow and Arthur J. Gallagher & Co. Insurance Brokers of California, Inc.- cc: * Heidi Rosevear Tiburon FPD (EMAIL), * Barb Clifford Tiburon FPD (FAX) The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. Certificate Delivery by CertificatesNow - www.ConfirmNet.corn - 877.669.8600 0 N N z Policy Number: VFIS-TR- 0022468 -10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: GENERAL LIABILITY COVERAGE PART Name of person or organization: Town of Tiburon [If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.] SECTION II. WHO IS AN INSURED is amended to include as an insured the person or organization shown above, but only with respect to liability arising out of your operations or premises owned by or rented to you. VGL300 (03/03) Copyright 2002 American Alternative Insurance Corporation. All Page 1 of 1 rights reserved. Includes copyrighted material of the Insurance GENERAL LIABILITY Services Office, Inc. with its permission. a, N N 00 N CA z w