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HomeMy WebLinkAboutCertificate of Insurance (2)CHAC-01 OP ID: E At ""%'L CERTIFICATE OF LIABILITY INSURANCE [DATE(M0/20YYY) 11 /20/2020 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 rit hts to the certificate holder in lieu of such endorsement(s). PRODUCER - 650-341-4484 BPIA Business Professional Insurance Associates CNgNPCT Debbie Upland (JFJ) - - - PHONE 650-34144484 FAX 650 -341 -4465 - AIC, No, Ext): (A/C, No): 1519 South B Street San Mateo, CA 94402 _ _ Eoo MESS: -- - — - — Debbie Upland (JFJ) INSURER(S) AFFORDING COVERAGE — NAIC # ERA, Employers Preferred Ins. Co. 10346 INSURED Community Health Awareness ~® Council dba CHAC—- VIRER B:NonProfits' Ins. Alliance ofCA 011845 INSURERC: 590 West EI Camino Real q qoq Mountain View, CA 94040 NOVU !r G G INSURER D: E: TOWN OF LOS ALTO In COVERAGES '"CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POI..JCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING A,NY REQUIREMENT',, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR AAY PERTAIN, INE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF'SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _EXCLUSIONS INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS B X -- COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ] OCCUR X 2020-04654 12/01/2020 12/01/2021 EACH OCCURRENCE $ 1,000,000 PREASESE aoccurence $ 500,000. .20;000 _ _ MED EXP (Any one person) $ ^ — PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ j� LOC'PRODUCTS GENERAL AGGREGATE $ 3;000,060 GEN'L X - COMP/OP AGG $ 3,000,000 OTHER: B AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT Ea accident) $ 1,000,000 BODILY INJURY Per person)$ ANY AUTO 2020-04654 12/01/2020 12/01/2021 OWNED SCHEDULE.`) AUTOS ONLY AUTOS --- -- BODILY INJURY Per accident $ — _ PROPERTY AMAGE Per accident $ X HIRED X NON -0 Nt.,7 AUTOS ONLY AUTOS ON!'. -- B X UMBRELLA LIAB X OCCURy EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 11000,000 EXCESS LIAB CLAIMr"MADE 20-20-04654-UMB 12/01/2020 12/01/2021 DED X RETENTION $ None A WORKERS COMPENSATION EMPLOYERS' LIABILITY nNYPROPR!ETOR/PARTNER/EXECUTIVEY/N i FFICER/MEMBER EXCLUDED? Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A EIG2738605-02 12/01/2020 12/01/2021 X STA TE ORH AND _F._LFACHAGCIO_F.NT$1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1'000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 B Improper Sexual 202 -04654 12/01/2020 12/01/2021 Occurrenc 1,000,000 Miscoonduct Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS ( VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate Holder is named as Additional Insured with respects to the insured's business operations.,!).kdditional Insured applies to General Liability policy only perform NIAC-E67. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road Los Altos, CA 94022 AUTHORIZED REPRESENTATIVE �/Y1lC iii- �� X44' ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NONPROFITS INSURANCE ALLIANCf, Or CALIFORNIA A-rlaadforinst!ranca. A Zrk for Nonprofits. THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR {' LESSORS OF PREMISES 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 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 only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury", caused, in whole or in part,', by your acts or omissions, or the acts or omissions of those acting on your behalf, subject to the following'yadditional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Any offense which constitutes "personal and advertising injury" which is committed. after you cease to be a tenant in that premises; or 3. Structural alterations, new construction or demolition operations performed by or an 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 the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insured, the following is adders 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. NIAC-E67 08 17 Page 1 of 1