|
6.E. =fie 11 of 18
<br />ACORN® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />0111512019
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT NAME: Linda White
<br />Thomas E Mestmaker & Assoc. License #01544996
<br />HONE Ext), (661) 327-3111 FAJX, No): (661) 327-1262
<br />A -MAIL : Lwhite@vOlsonpaves.com
<br />c/o Wilson Paves & Assoc. Lic # OE50885
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />3636 Pegasus Drive
<br />Bakersfield CA 93308
<br />INSURERA : Allied World Insurance Company 22730
<br />INSURED
<br />INSDRERB : Non -Profits' United Vehicle Insurance Pool
<br />Redwood City Police Activities League
<br />INSURERC : State Compensation Ins Fund 35076
<br />INSURERD : Arch Insurance Group Inc. 11150
<br />3399 Bay Rd.
<br />INSURER E
<br />Redwood City CA 94063
<br />INSURER
<br />COVERAGES CERTIFICATE NUMBER: 19-20GL,Acc,BA,Umb,WC 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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICYNUMBER
<br />MMIDDIYI'
<br />MMIDDIYYY
<br />LIMITS
<br />Redwood City CA 94063
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE � OCCUR
<br />PREMISES Ea occurrence -{, 300,000
<br />MED EXP (Any one person) -I Excluded
<br />PERSONAL & ADV INJURY J: 1,000,000
<br />A
<br />Y
<br />5075126800
<br />01/01/2019
<br />01/01/2020
<br />'L AGGREGATELIMIT APPLIES PER
<br />GENERAL AGGREGATE $ 3,000,000
<br />POLICY PES F—]LOQ:-
<br />R
<br />PRODUCTS - COMPIOPAGG $ 1,000,000
<br />SEXUALABUSE $ 100,000
<br />OTHER.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT ¢, 2,000,000
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />B
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />2088
<br />07/01/2018
<br />07/01/2019
<br />BODILY INJURY (Per accident) $
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />fPer accidenCl
<br />Underinsured motorist f 3,500
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />EXCESS LIAB
<br />HCLAIMI-MADE
<br />PENDING
<br />01/31/2019
<br />01/31/2020
<br />AGGREGATE $
<br />DED I X1 RETENTION $ 10,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY v r N
<br />ANY PROPRIRIPARTNCUTIVE F71,000,000
<br />JFFICERfMEMBMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />901842918
<br />07112/2018
<br />0711212019
<br />PER OTH-
<br />STATUTE ER
<br />E. L. EACH ACCIDENT {
<br />E. L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICY LIMIT $ 1,000,000
<br />Accident/Medical
<br />D
<br />SPNO01011301-0057
<br />01/01/2019
<br />01/01/2020
<br />Limit $50,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Redwood City, its officers, agents, employees and volunteers are added as additional insured to the General Liability Policy per the attached
<br />form#GL 800000008 00 subject to the terms, conditions and exclusions of the policy. A written contract is required for the additional insured to be valid.
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACO RD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2019.021/REDWOOD CITY POLICE ACTIVITIES LEAGUE 58
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />The City of Redwood City
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />1017 Middlefield Rd.
<br />AUTHORIZED REPRESENTATIVE
<br />Redwood City CA 94063
<br />(_
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACO RD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />ATTY/AGR.2019.021/REDWOOD CITY POLICE ACTIVITIES LEAGUE 58
<br />
|