|
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 />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />2/20/2024
<br />AssuredPartners Design Professionals Insurance Services,LLC
<br />3697 Mt.Diablo Blvd Suite 230
<br />Lafayette CA 94549
<br />Jennifer Aguirre
<br />626-381-9091
<br />CertsDesignPro@AssuredPartners.com
<br />License#:6003745 XL Specialty Insurance Co.37885
<br />BIGGCAR-01 Sentinel Insurance Company 11000BiggsCardosaAssociates,Inc.
<br />865 The Alameda
<br />San Jose CA 95126
<br />Hartford Accident and Indemnity Company 22357
<br />HARTFORD INSURANCE COMPANY 38288
<br />569097255
<br />B X 1,000,000
<br />X 1,000,000
<br />X Contractual Liab 10,000
<br />Included 1,000,000
<br />2,000,000
<br />X X
<br />Y Y 57SBWBO6247 9/1/2023 9/1/2024
<br />2,000,000
<br />C 1,000,000
<br />X
<br />X X
<br />Y Y 57UEGBD0434 9/1/2023 9/1/2024
<br />B X X 9,000,000Y57SBWBO62479/1/2023Y 9/1/2024
<br />9,000,000
<br />X 10,000
<br />D XY57WEGAT6XHA9/1/2023 9/1/2024
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Professional Liability &
<br />Pollution Liability Included DPR5024553 3/1/2024 3/1/2025 Per Claim
<br />Aggregate Limit
<br />$5,000,000
<br />$9,000,000
<br />The Umbrella Policy is follow form to its underlying Policies:General Liability/Auto Liability/Employers Liability/Employee Benefits Liability.
<br />Re:All Operations of the Named Insured -The City of Pleasanton ,its officers,employees and agents are named as Additional Insured as respects General and
<br />Auto Liability as required per written contract.General Liability insurance is Primary/Non-Contributory per policy form wording.Insurance coverage includes
<br />Waiver of Subrogation per the attached.30 Days Notice of Cancellation.
<br />30 Day Notice of Cancellation
<br />City of Pleasanton
<br />Attn:City Clerk's Office
<br />P.O.Box 520
<br />Pleasanton CA 94566
<br />Docusign Envelope ID: C64BC08E-2CCD-4873-9B0A-B685BD62B746Docusign Envelope ID: BF50E8C8-8468-4FA8-9EB6-C97DCFDE8D97
|