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HULBE-1 OP ID:TC
<br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
<br /> 0 911 8/2 01 4
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
<br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
<br /> the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT
<br /> Archway-Clayton Ins Agency Inc NAME:
<br /> PHONE FAX
<br /> OD63171 vc No:
<br /> 1731 Technology Dr.,Ste.,260 AEp Ess:
<br /> San Jose,CA 96110
<br /> House Account INSURER(M AFFORDING COVERAGE NAIC 0
<br /> INSURERA:Travelers Property Casualty Co
<br /> INSURED Hulberg&Associates INSURER B:Republic Indemni Insurance 03012
<br /> One North Market Street INSURER 0:Houston Casualty Company
<br /> San Jose,CA 95113 INSURER D:Lloyds Of London
<br /> INSURER E:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br /> IN
<br /> LTR SR TYPE OF INSURANCE POLICY EFF POLICY EXP
<br /> POLICY NUMBER M/DD/YYYY 1 (MMIDDNYYYI LIMITS
<br /> GENERAL LIABILITY
<br /> EACH OCCURRENCE $ 1,000,000
<br /> A X COMMERCIAL GENERAL LIABILITY X 1680986WO446TCT14 01/03/2014 01/03/2015 EMI E Ea occurrence $ 300,00
<br /> CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00
<br /> PERSONAL&ADV INJURY $ 1,000,00
<br /> GENERAL AGGREGATE $ 2,000,00
<br /> GERL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,00
<br /> POLICY X PRO LOC $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> Ee accident 1,000,00
<br /> A ANY AUTO 1680985WO445TCT14 01/03/2014 01/03/2016 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY Per accident $
<br /> AUTOS AUTOS ( )
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> AUTOS PER A IDEN $
<br /> $
<br /> UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00
<br /> A X EXCESS LWB CLAIMS-MADE CUP98SWO4701442 01/03/2014 01/03/2016 AGGREGATE $ 2,000,00
<br /> DED I X I RETENTION 0 $
<br /> WORKERS COMPENSATION X WC STATU- OTH-
<br /> AND EMPLOYERS'LIABILITY
<br /> B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N 17946605 02/02/2014 02/02/2016 E.L,EACH ACCIDENT $ 1,000 00
<br /> OFFICER/MEMBER EXCLUDED? El N/A
<br /> i
<br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00
<br /> DESGRIPTIIOONN OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00
<br /> C Employ Practice H713907107 11/15/2013 11/16/2014 4500 Ret. 1,000,00
<br /> D Professional Liab MPL119321614 01/26/2014 01/26/2015 $6000 Ded 3,000,00
<br /> i
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
<br /> The City, its officers, agents, employees and volunteers are included as
<br /> additional insured per form #CGD251 0805 attached.
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> REDWO-1
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> CI of Redwood CI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> ry City ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Robert B Bell,City Manager
<br /> 1017 Middlefield Road AUTHORIZED REPRESENTATIVE
<br /> ' Redwood City,CA 94063
<br /> 01988-2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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