CITYSERVE OF THE TRI-VALLEY - PLHA FUNDS

Policy Numbe r: Date Entered : 12/28/2023 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (M M/00/YYYY) ~ 12/28/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANO 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER. IMPORTANT : If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder i n lieu of such endorsement(s). PRODUCER ~~~~~cT LN Mendez nicole@alleninsurance.net Allen Insurance PHONE (925)820 -9090 I~~~. No ): (925)820-9028 185 Street, Ste . 204 lA/C No E xtl: Front E-MAIL CA 94526 ADDRES S: Danville, INSURER($) AFFORDING COVERAGE NAIC# IN SURER A : United States Liability Insurance < ~5895 INSURED City Serve of the Tri-Valley INSURER B : Employers Preferred Ins Co 11512 Eric Hom INSURER C: PO Box 1613 IN SURER D: Pleasanton, CA 94566 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIE S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOlWITHSTANDING AN Y REQUIREMENT , TERM OR CONDITION OF AN Y CONTRACT OR OT HER DO CUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AF FORD ED BY THE POLICIES DESCRIBED HER EIN IS SUBJECT TO ALL THE TERMS , EXCL USION S AND CONDITIONS OF SUC H POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR POLI CY EFF POLI CY EXP LIMITS LTR TYPE OF INSURAN CE INS0 WYO POLI CY NUMBE R IM M/00 /YYY YI IM M/00 /YYY YI lX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1 ,000 ,000 D CLAIMS-MADE ~ OCCUR X U /"\IVV'\UC. I U ~1 llt:.U A NPP1616019A 01 /26/2 024 01/26 /2025 PREMISES IEa occurrence\ $100 ,000 ,__ ,__ MED EXP (M y one peison ) $ 5 ,000 PERSONAL & ADV INJURY $ Excluded -GENLAGGR EGATE LIMI T AP PLI ES PER: GENERAL AGGREGATE $3,000,000 M □PRO-□Loe PRODUCTS -COMP/OP AGG $ Excluded POL ICY JE CT OTHER: $ AUTOMOBI LE LIABILI TY (Ea accidentl:;IN<.;Lt: LI MI $ 1 ,000 ,000 ,__ X /WYAUTO BOD ILY INJURY (Per person ) $ ,__ - A OWN ED SC HED ULE D NPP1616019A 01/26/202 4 01 /26/2 0 25 BOD ILY INJ URY (Per accident) $ AUTOS ONLY AUTOS ~ HI RED z NON-OWN ED (~';';~ck:it)""''-'IC $ AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB HOCCUR EAC H OCCURRENCE $ ,__ EX CESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENT ION $ $ WOR KERS COMPENSATION YI STATUTE I I ERn-AND EMR LOYERS' LIABILITY Y/N B ANY PROPRIETOR /PART NER /EXECUT IVE □ N/A EIG 4602416 03 09 /07 /2 0 2 3 09/07 /202 4 E.L. EACH ACCI DENT $1 ,000,000 OFFICER/MEMBER EX CLUDED ? (Mandatory in NH) E.L. DISEASE -EA EMPLOYE E $1,000,000 grs5c~~~ '8l=~ERA TIONS below E.L. DISEAS E -POLICY LIMIT $1,000,000 E&O Ea Incident $1 ,000 ,000 A Professional E&O Liab . X NPP1616019A 0 1/26/202 4 01/2 6 /202 5 E&O Aggregate $3,000 ,000 DES CRIPTIO N OF OPERATIONS I LOCATIONS / VEHIC LES (ACORD 101 , Add itional Remarks Schedule, m ay be attached if more spac e is r equired ) The City of Pleasanton, its officers , officials , as insureds in respects to liability arising out the Tri-Valley . CERTIFICATE HOLDER The City of Pleasanton PO Box 520 Pleasanton , CA 94566 employees and designated volunteers are to be covered of activities performed by or on behalf of City Serve c CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVER ED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU THORIZED REPRESE NTA TIVE R . casey Allen ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD f DocuSign Envelope ID: 5F7F0DD3-A23A-40A0-BB95-4728BC0C6B49