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AgdaPkt 2017-06-12 Joint SA PFA
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AgdaPkt 2017-06-12 Joint SA PFA
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Last modified
6/13/2017 11:00:53 AM
Creation date
6/8/2017 2:54:33 PM
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Template:
CC Index
CC Index - Document Type
Agenda Packet
Meeting Type
Joint
Agency Type
City Council and Successor Agency and Public Financing Authority
Date
6/12/2017
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The ACORD name and logo are registered marks of ACORD <br />CERTIFICATE HOLDER <br />©1988-2014 ACORD CORPORATION.All rights reserved. <br />ACORD 25 (2014/01) <br />AUTHORIZED REPRESENTATIVE <br />CANCELLATION <br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE <br />LOCJECTPRO-POLICY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OCCURCLAIMS-MADE <br />COMMERCIAL GENERAL LIABILITY <br />PREMISES (Ea occurrence)$DAMAGE TO RENTED <br />EACH OCCURRENCE $ <br />MED EXP (Any one person)$ <br />PERSONAL &ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS - COMP/OP AGG $ <br />$RETENTIONDED <br />CLAIMS-MADE <br />OCCUR <br />$ <br />AGGREGATE $ <br />EACH OCCURRENCE $UMBRELLA LIAB <br />EXCESS LIAB <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />INSR <br />LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS <br />PER <br />STATUTE <br />OTH- <br />ER <br />E.L.EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />$ <br />$ <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />If yes,describe under <br />DESCRIPTION OF OPERATIONS below <br />(Mandatory in NH) <br />OFFICER/MEMBER EXCLUDED? <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y / N <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />HIRED AUTOS NON-OWNED <br />AUTOS AUTOS <br />AUTOS <br />COMBINED SINGLE LIMIT <br />BODILY INJURY (Per person) <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE $ <br />$ <br />$ <br />$ <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 />INSD <br />ADDL <br />WVD <br />SUBR <br />N / A <br />$ <br />$ <br />(Ea accident) <br />(Per accident) <br />OTHER: <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(ies) 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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />INSURED <br />PHONE <br />(A/C, No, Ext): <br />PRODUCER <br />ADDRESS: <br />E-MAIL <br />FAX <br />(A/C, No): <br />CONTACT <br />NAME: <br />NAIC # <br />INSURER A : <br />INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />INSURER(S)AFFORDING COVERAGE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />INS025 (201401) <br />4/20/2017 <br />Professional Insurance Associates <br />Gordon Associates K-2 <br />P.O. Box 1266 <br />San Carlos CA 94070 <br />Jeff Stephens <br />(650)654-5555 (650)654-5550 <br />jstephens@gordoninsurance.com <br />Peninsula Celebration Association <br />463 Brewster St., Suite 4 <br />Redwood City CA 94063 <br />Philadelphia Insurance Companies <br />CL1741809551 <br />A <br />X <br />X <br />X <br />X PHPK1635071 5/20/2017 5/20/2018 <br />1,000,000 <br />100,000 <br />5,000 <br />1,000,000 <br />3,000,000 <br />3,000,000 <br />Liquor Liability per occurrence 1,000,000 <br />A <br />X X <br />X 10,000 PHUB579133 5/20/2017 5/20/2018 <br />2,000,000 <br />2,000,000 <br />Certificate is for Peninsula Celebration Association. City of Redwood and its Council, and their boards, <br />officers, commissions, emploees, volunteers, and agents (collectively, the "City-Insureds") are <br />additional insureds, insuring the same against all claims for personal injury or death to any persons or <br />person resulting or arising from the conduction of the activities therefrom or from any act of omission <br />to act of the Premitee in conjuction therewith. Should any of the above-described policies be cancelled <br />before the expiration date thereof, notice will be delivered in accordance with the policy provisions. <br />30 days notice of cancellation and 10 days notice will be given for nonpayment of premium will be given. <br />David Gordon/CASSIE <br />City of Redwood City <br />1017 Middlefield Road <br />Redwood City, CA 94063-1993 <br />6.3.F. - Page 30
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