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HomeMy WebLinkAboutCertificate of InsuranceREGIGOV-02 AGARCIA3 i CERTIFICATE OF LIABILITY INSURANCE DATE (MM/023YY) 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 License # OC36861 Irvine-Alliant Insurance Services, Inc. 18100 Von Karman Ave 10th FI Irvine, CA 92612 CONTACT Anne Krueger AM E: PHONE 949 260-5087 FAX No (A/C, Ext): ( ) IL Aoo IEss: AKrueger@alliant.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Great American E & S Insurance Company 37532 INSURED INSURER B : INSURER C: REGIONAL GOVERNMENT SERVICES AUTHORITY INSURER D : PO BOX 1350 CARMEL VALLEY, CA 93924 E: -INSURER INSURER F : DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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 L TYPE OF INSURANCE ADDL SD SUBR WVD POLICY NUMBER POLICY EFF M DD POLICY EXP M DD Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE X OCCUR X 214510006 9/29/2023 9/29/2024 DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP Anyoneperson) $ 0 X GL DED: $50,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 X POLICY ❑ In FILOC PRODUCTS - COMP/OP AGG 5,000,000 $ OTHER: A AUTOMOBILE LIABILITY ED (Ea accidentSINGLE LIMIT $ 5,000,000 BODILY INJURY Perperson) $ ANYAUTO 214510006 9/29/2023 9/29/2024 BODILY INJURY Per accldent $ OWNEDSCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident X HIRED X NON -OWNED AUTOS ONLY AUTOS OONLY $ X $50T000ED: UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE DED TTRETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N STATUTE OERH OFFICERIMEMBER EXCLUDEID? ECUTIVE ❑ (Mandatory In NH) NIA E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A PUBLIC OFFICIALS E&O 214510006 9/29/2023 9/29/2024 LIMIT 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured endorsement attached. Policy form does not contain a General Liability Aggregate. Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. Subject to policy terms, conditions and exclusions. Carriers on Policy: Great American E&S Insurance Company StarStone Specialty Insurance Company SEE ATTACHED ACORD 101 Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID. REGIGOV-02 LOC #: ADDITIONAL REMARKS SCHEDULE AGENCY License # OC36861 NAMED INSURED Irvine-Alliant Insurance Services, Inc. REGIONAL GOVERNMENT SERVICES AUTHORITY PO BOX 1350 POLICY NUMBER CARMEL VALLEY, CA 93924 EE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance AGARCIA3 Page 1 of 1 Description of Operations/Locations/Vehicles: AS RESPECTS SERVICE CONTRACT. TOWN OF LOS ALTOS HILLS AND ITS OFFICERS, EMPLOYEES AND AGENTS SHALL BE NAMED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY ONLY ARISING OUT OF THE OPERATIONS BY OR ON BEHALF OF THE NAMED INSURED. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. ACORD 101 (2008/01) © 2008 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 - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON-PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Personal Injury" (including `Bodily Injury") and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. GL330138 0916 Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission THLS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Primary and Non -Contributory Coverage Endorsement This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON-PROFIT CORPORATIONS The following is added to Section VIIL COMMON POLICY CONDITIONS: If insurance similar to this insurance is held by a person or organization that is an additional insured on this policy, this insurance is primary to that other insurance. The "Company" shall not seek contribution from that other insurance for amounts payable under this insurance for liability arising out of the "Participating Named Insured's" ongoing operations performed for that person or organization undera written agreement. However, the provisions of this endorsement do not apply to a person or organization unless the "Participating Named Insured" had a written agreement with that person or organization requiring: a. This insurance be primary insurance; b. They be an additional insured on this Policy; and C. The written agreement was entered into prior to the date the "Participating Named Insured's" operations for that person or organization commenced. GL330152 0911 Includes copyrighted material of ISO, Inc., used with permission Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUBROGATION This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON- PROFIT CORPORATIONS The following is added to Section VIII. COMMON POLICY CONDITIONS: (D) Subrogation. To the extent of any payment hereunder, the "Company" shall be subrogated to all of the "Insured's" rights of recovery, therefore; and the "Insured" shall do nothing after loss to prejudice such rights and shall do everything necessary to secure such rights. Any amount so recovered shall be apportioned as follows: Any interest, includin the "Insured's", having paid an amount in excess of any "Participating Named Insured's" Sel_ Insured Retention plus the Limit of Liability hereunder shall be reimbursed first to the extent of actual payment. The "Company" shall be reimbursed next to the extent of its actual payment hereunder. If any balance then remains unpaid, it shall be applied to reimburse the "Participatm� Named Insured". The expenses of all such recovery proceedings shall be apportioned in the ratio of the respective recoveries. If there is no recovery in proceedings conducted solely by the "Insured", it shall bear the expenses thereof. However, the "Company" will waive its right of subrogation against any person or organization for whom the "insured' is performing operations, but only if: 1) That person or organization requires in the written agreement with the "Participating Named Insured" that the "Participating Named Insured" waive its right of recovery against that person or organization; and 2) The written agreement is made prior to the date of the "Occurrence". Includes copyrighted material of ISO Properties, Inc., 2004 with its permission Page I of I GL330299 0916 Page 1 of 1 Ed 0916