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08
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2014
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111814
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08
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Last modified
8/27/2015 11:28:03 AM
Creation date
11/14/2014 10:41:29 AM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
11/18/2014
DESTRUCT DATE
15Y
DOCUMENT NO
8
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A�d CERTIFICATE OF LIABILITY INSURANCE DATE(MMDONYTY) <br /> 10/20/2014 <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 /> — <br /> IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the tams 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 /> NAME: <br /> Marron Insurance Services HONE 310-514-8425 I ire 310-5148688 <br /> 1891 N.Gaffey Street,Suite 236 ADDRESS: becky@marronins.com <br /> San Pedro, CA 90731 INSURERS)AFFORDING COVERAGE /WC 0 <br /> INSURER A:United States Fire Insurance Company 21113 <br /> INSURED <br /> INSURER B: <br /> CleanStreet, Inc. <br /> INSURER C: <br /> DBA:California Street Maintenance INSURERD: <br /> 1937 W 169th Street • INamERE: <br /> Gardena,CA 90247 <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 /> INSR AWL OF INSURANCE AWL SUB POLICY EFF POLICY EXP <br /> LTR INSD WVD POLICY NUMBER ,(MM/DD/YYYYI IMMOD/YYYYI LIMITS <br /> A X COMMERCIAL GENERAL LIABILITY X 506-8763082 04/01/14 04/01/15 EACH OCCURRENCE $ 1,000,000 _ <br /> CLAIMS-MADE X OCCUR DAMAGETO RENTED 1,000,000 <br /> PREMISES(Ea occurrence) S <br /> MED EXP(Any one person) $ 10,000 <br /> PERSONAL BADV INJURY S 1,000,000 <br /> GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 <br /> POLICY X jECT I I LOC PRODUCTS-COMP/OP AGO 3 2,000,000 <br /> OTHER $ <br /> A AUTOMOBILE LIABILITY 506-8763082 04/01/14 04/14/15 COMBINEDdaml SINGLELIMIT $ 1,000,000 <br /> fEeam <br /> I X ANY AUTO BODILY INJURY(Per person) $—1,_ Aa OrNE0 _ SCHEDULED BODILY INJURY(Per accident) 3 <br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS (Per accMoml <br /> I 3 <br /> A X UMBRELLA LAB X OCCUR 523-7088399 04/01/14 04/01/15 EACH OCCURRENCE s 5,000,000 <br /> EXCESS LIAO CLAIMS-MADE AGGREGATE S 5,000,000 <br /> LIED I RETENTION$ $ <br /> YORKERS COMPENSATION PLR OTH- <br /> AND EMPLOYERS LJABILJTY Y/N STATUTE ER <br /> ANY PROPRIETOR/PARTNER,EXECL/TIVE E.L.EACH ACCIDENT S <br /> OFF/CERA/EMBER EXCLUDED? I NIA <br /> (Mandatory M NH) E.L.DISEASE-EA EMPLOYEE S <br /> If yes,desvme Mbar <br /> DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addwonsl RmMrks Schedule,may be attached N more space Is rpulred) <br /> City of Pleasanton, its Officers, Employees and Agents are named as Additional Insured per attached <br /> endorsements. <br /> **10 Day notice will apply for non payment of premium.** <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Pleasanton ANY Old Bernal Avenue THE UL EXPIRATION DATE OVE <br /> THEREOF,DESCRIBED NOTICE POLICIES WILL CBE CDELIVERED IN <br /> Pleasanton, CA 94566 ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> (ea ziot <br /> I <br /> ©1988-2013 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2013/04) The ACORD name and logo are registered marks of ACORD <br />
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