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HomeMy WebLinkAboutWestwind Riding Institute (4)W9:CTW_1 f1D Ill• Lei CERTIFICATE OF LIABILITY INSURANCE E (MMID D/YYYY) 0DATE 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, certainpolicies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 916-669-1362 Sypolt Insurance Services, Inc 11344 Coloma Road, Suite 635 Gold River, CA 95670_ Mary Blincoe Sypolt CONTACT Kristi Lindsey PHONE 916-669-1362 FAX 916-669-1363; (A/C, No, Ext): A/C, No EMAIL kristi sisins.com ADDRESS INSURERS AFFORDING COVERAGE NAIC # INSURER A: Arclonaut Insurance Co 08/20/2019 INSURED est In Riding Institute estin 4-H Riding for the Handicapped C/O Nancy Couperus 27210 Altamont Road Los It Hills, CA 94022 INSURER B : INSURER C : INSURER D: INSURER E : INSURER F: PERSONAL & ADV INJURY $ 1,000,000 CCLVFRAnFC CFRTIFICATF NIIMRFR REVISION Nt1MRFR! 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR X ELP0208939-02 08/20/2019 08/20/2020 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENc ED ce $ 50,000 ro MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PE LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABILITY A ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS �/ AGT OS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea c'de BODILY INJURY Perperson) $ _ BODILY INJURY Per accident $ PeOr accRdentDAMAGE $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ONFFICER/EES�EXCLUD? PROPRIETOR/PARTNER/EXECUTIVE ❑ (Mandatory in NH) If yes, dePTIONscribe under DESCRIF OPERATIONS below N / A PER 0TH - STATUTE ER-- E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE. $ I E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS LISTED AS AN ADDITIONAL INSURED ON THE POLICY AS PER THE CONDITIONS OF ENDORSEMENT #EPL312 (05/16) ATTACHED C'FRTIL:If'ATF 41011 IIFR CANCF_I_I_ATION 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, TOWN OF LOS ALTOS HILLS 27210 ALTAMONT ROAD LOS ALTOS HILLS, CA 94022 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART EQUINE CARE, CUSTODY, OR CONTROL COVERAGE PART SECTION II — WHO IS AN INSURED is amended to include the person or organization shown in the Schedule below, but only as respects liability imposed or sought to be imposed on such additional insured because of an alleged act or omission of the Named Insured. 1. If liability for injury or damage is imposed or sought to be imposed on the additional insured because of: a. Its own acts or omissions, this insurance does not apply; b. Its acts or omissions and those of the Named Insured, as to defense of the additional insured, this insurance will act as coinsurance with any other insurance available to the additional insured, in proportion to the limits of insurance of all involved policies, and the Other Insurance provisions of this policy (SECTION IV - CONDITIONS) are amended accordingly. However, this insurance does not apply to indemnity of the additional insured for its own acts or omissions. 2. If an agreement between the Named Insured and the additional insured providing indemnity or contribution in favor of the additional insured exists or is alleged to exist, the extent and scope of coverage under this insurance for the additional insured will be no greater than the extent and scope of indemnification of the additional insured which was agreed to by the Named Insured. SCHEDULE Town of Los Altos Hills Victoria Dye Equestrian, Westwind Barn ELP 312 (05/16) Page 1 of 1 Attachment Preferred ANR Use Agreement ATTACHMENT D - RECIPROCAL CLAUSES University of California Division of Agriculture and Natural Resources Cooperative Extension The Westwind Ridinq for the Handicapped Program of Santa Clara County, as a program of The Regents of the University of California, Agriculture and Natural Resources, Cooperative Extension, is hereby authorized during the period from 9/1/19 through 8/31/24 , to use the following described facility/land: Westwind 4-H Barn & Riding Arenas at Westwind Community Barn for the purpose of: Riding for the handicapped THE REGENTS OF THE UNIVERSITY OF CALIFORNIA shall defend, indemnify and hold The Town of Los Altos Hills , its officers, employees, and agents harmless from and against any and all liability, loss, expense (including reasonable attorneys' fees), or claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, its officers, agents or employees. The Town of Los Altos hills shall defend, indemnify and hold THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, its officers, employees and agents harmless from and against any and all liability, loss, expense (including reasonable attorneys' fees), or claims for injury or damages arising out of the performance of this Agreement but only in proportion to and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of C fill in name of other entity orperson(s) j, its officers, agents or employees. auir D' a tor'sa an Si nat re: t�y Date: July 26, 2 19 County Name: Santa Clara, CA University of California Division of Agriculture & Natural Resources Cooperative Extension Authorized NameM'gn of the other entity: Y& ( Date:�®� Expiration Date of Use Agreement: 2132 i � __ L USE THIS LANGUAGE WHEN THE OTHER ENTITY OR PERSON DOESN'T HAVE AN AGREEMENT. YOU MUST OBTAIN AN INSURANCE CERTIFICATE FROM THEM TO BACK UP THE LANGUAGE IN THE AGREEMENT. No. ANR 465 2018/19 This Certificate is issued to: Westwind Community Barn 27210 Altamont Road Los Altos, CA 94022 University of California Agriculture & Natural Resources Office of Risk Services 2801 Second Street Davis, CA 95618-7774 (530) 750-1263 Fax: (530) 756-1113 UNIVERSITY OF CALIFORNIA CERTIFICATE OF SELF-INSURANCE This is to certify that the University of California is self-insured for the following coverages: Type of Coverage Self -Insured Limits I. GENERAL LIABILITY: Each Occurrence $1,000,000.00 Products and Completed Operations Aggregate $1,000,000.00 Personal and Advertising Injury $1,000,000.00 General Aggregate (Bodily Injury & Property Damage) $1,000,000.00 11. AUTOMOBILE LIABILITY: Vehicles owned, Non -owned $ and Hired each occurrence III. SPECIAL TERMS & CONDITIONS: 1. Westwind Community Barn, its officers, agents and employees are hereby named as additional insured but only in connection with ANR 465 a sanctioned Regents activity, conducted through the auspices of Santa Clara County Cooperative Extension 4-H Program for Westwind Riding for the Handicapped Theraputic Riding Activities held during the period August 1, 2019 through July 31, 2024. Specific times, dates and activities which invoke this certificate must be attached to the certificate in order to be covered. This provision shall apply to all claims, costs, injuries, or damages, but only in proportion to and to the extent such claims, costs, injuries, or damages are caused by or result from the negligent acts or omissions of the Regents of the University of California, its officers, agents, or employees. 2. The insurance evidenced herein follows the provisions of the Bylaws and Standing Orders of The Regents of the Universityof California and Self -Insurance Programs as administered by the University of California, Office of the President, Office of Risk Services, which does not permit any assumption of liability which does not result from and is not caused by the negligent acts or omissions of its officers, agents, or employees. Any indemnification or hold harmless clause with broader provisions than required under such Bylaws and Standing Orders shall invalidate this certificate. Should any of the above described programs of self-insurance be modified or cancelled before the expiration date shown below, The Regents of the University of California will give 30 days written notice to the named certificate holder. DATE ISSUED: July 29, 2019 CERTIFICATES EXPIRES: August 1, 2024 AUTHORIZED SIGNATURE Linda Harris Risk Services Analyst Division of Agriculture & Natural Resources Pooled Liability Assurance Network JPA 1750 Creekside Oaks Drive, Suite 200, Sacramento, CA 95833 916-244-1100 Liability Certificate of Coverage Evidence of Coverage Certificate Number: 50530799 Certificate Holder: University of California Division of Agriculture and Natural Resources Attn: Linda Harris 2801 Second Street Davis, CA 95618 Covered Party: Town of Los Altos Hills Description of As respects evidence of general and auto liability coverage for the City of Los Altos Hills regarding the Covered Activity: Westwind Riding for the Handicapped Program. Memorandum of Coverage Number: GAL 2019-20 Effective Date: 08/06/2019 Expiration Date: 7/1/2020 Limits: $5,000,000 (per occurrence) The Following General and automobile liability as defined in the Memorandum of Coverage on file with the covered party Coverage is in named above. effect: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend, or alter the coverage afforded by the Liability Memorandum of Coverage. This is to certify that the coverage listed above has been issued to the Covered Party named above for the coverage 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 coverage afforded as described herein is subject to all the terms, exclusions, and conditions of the Memorandum of Coverage of the PLAN, which is available for your review upon request. Coverage is in effect from 12:01 a.m. Pacific Time of effective date to 12:01 a.m. Pacific Time of expiration date as stated above and will not be canceled, limited, or allowed to expire except upon 30 -day notice to the certificate holder. Date Issued: 8/12/2019 Renewal: Yes Excess Certificate Issued: No Authorized Representative Signature: 50530799 1 PLAN 1 19/20 GL $5MM LIMITS I Brenneca Kidd 1 8/12/2019 1:30:12 PM (PDT) I Page 1 of 1