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HomeMy WebLinkAboutCertificate of InsuranceCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/22/2021 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(les) must have ADDITIONAL INSURED provisions or 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 Business Professional Insurance Associates _ CoNT: CT NAMETirzah Tyler 1519 South B Street San Mateo, CA 94402 PHONE A/C No Ext • (650)34'1-4484 A/C No): (650)341-4465 A MAIDDRELss: TTler b Ia y p• ,net INSURERS AFFORDING COVERAGE NAIC # License #: OD69286 INSURERA: Nonprofits Insurance Alliance of CA 01184 INSURED CHAC INSURERS : Emialo ers Preferred Ins. Co. 10346 INSURER C: DBA Community Health Awareness Council INSURER D: _ 590 W EI Camino Real INSURER E: Mountain View, CA 94040-2612 -- INSURER F COVERAGES GERIIFICATE NUMBER: 000 0323 0-81 271 0 RFVIS10KI NI IMRFR• a 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 LTR TYPE OF INSURANCE ADDL D SUBR D POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y 2021-04654 12/01/2021 12/01/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTI-) PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 20,000 X Empl Ben Liab. PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JEC LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS -COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITY 2021-04654 12/01/2021 12/01/2022 Ea aocld.n,)S GLE LIMIT $ 1 OOO OOO ANY AUTO BODILY INJURY (Per person) $ X OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY BODILY INJURY Per accident $ ( ) PROPERTY DAMAGE Per accident $ $ A UMBRELLALIAB�( OCCUR 2020-04654-UMB 12/01/2021 12/01/2022 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DE I X I RETENTION $ None $ B WORKERS COMPENSATIONAND EMPLO EMPLOYERS' YIN ANY PROPRIETOR/PARTNER/E OFFICER/MEMBER EXCLUDED? ECUTIVE "N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below p /� EIG273860503 12/01/2021 12/01/2022 X STATWE IiH E.L, EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Improper Sexual Cond 2021-04654 12/01/2021 12/01/2022 Occur/Aggr. 1 mil/1 mil A Soc. Serv. Prof Liab 2021-04654 12/01/2021 12/01/2022 Occur/Aggr. 1 mil/2 mil DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) Certificate Holder is named as Additional Insured with respects to the insured's business operations. Additional Insured applies to General Liability policy only. CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are reqistered marks of ACORD Printed by THT on 11/22/2021 at 10:30AM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills 26379 Fremont Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Los Altos, CA 94022 AUTHORIZED REPRESENTATIVE Z� I --------------- L - THT) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are reqistered marks of ACORD Printed by THT on 11/22/2021 at 10:30AM POLICY NUMBER: 2021-04654 Named Insured: CHAC COMMERCIAL GENERAL LIABILITY CG 20 11 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS 0,71 LESSORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or agreement currently in effect, or becoming effective during the term of this policy. Additional Premium: Included Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by thecontract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 11 12 19 © Insurance Services Office, Inc., 2012 Page 1 of 1