|
A r-Ar�i Ar SANSGAR-YI cnu I
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY)
<br />3/28/2025
<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 License* 0172684 CONTACT Sharon Pillman, CIC, CAWC, CISR
<br />CoreMark Insurance Services Inc. P -- -- _
<br />PHONE --- -- _-.._-..-_-_.---___-._
<br />4430 Duckhorn Drive (A/C, No, Ext): (916) 779-6973 FAX
<br />Sacramento, CA 95834 EMAIL - - _ _-T(A/C, No):(916) 923-2797
<br />ADDRESS_ [email protected]
<br />- -_ -_ INSURER(SZAFFORDING COVERAGE NAIC #
<br />- INSURER United Specialty Insurance Company
<br />-- - - _- _ c
<br />P - ty- - — - 12537
<br />INSURED -
<br />INSURER s. -Arch Insuran_ ce Company_ 11150
<br />--
<br />New CompanyIma a-- - - -
<br />9 Pe INSURER C Nav�ators Insurance Com�an� - 42307
<br />3250 Darby Common -- -_
<br />Fremont, CA 94539 INSURER D
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CFRTICIL`ATC r u usnee.
<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 />R I - -- - TYPE OF INSURANCE IAN nLl_y yp f POLICY NUMBER --- - POLICY �EFF POLICY EXP ----- ------ - - -- - --
<br />X COMMERCIAL GENERAL LIABILITY
<br />(MM/DD/YYYY 1 LIMITS
<br />EACH _ $ 1,000,000
<br />CLAIMS MADE X OCCUR 026 4/1/2025 4/1/2
<br />X X ATN25110608 DAMAGE TO RENTED 50 OOO
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Pleasanton is an additional insured with primary wording per attached CG2010 0413 and CG2037 0413, primary wording applies per VEN05100 0220.
<br />General Liability waiver of subrogation applies per attached CG2404 0509. Auto Additional Insured applied per attached AC7005 0316. Work Comp Waiver of
<br />subrogation applies per attached
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Pleasanton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />123 Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Pleasanton, CA 94566
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />-MI$ES (Ea occurrence -
<br />$_
<br />MED EXP tAny one-personL- -
<br />$ 51000
<br />_$ - -
<br />PERSONAL &ADV INJURY
<br />-
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY LOC
<br />GENERAL AGGREGATE _
<br />- -
<br />$ 2,000,000
<br />JECT
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />HER:
<br />- - - -
<br />-- - -
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />L accident)_
<br />$
<br />; 1,000,000
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />ZACAT1206001
<br />7/1/2025
<br />1/1/2026
<br />- -
<br />BODILY INJURYjPer�ersonZ
<br />-
<br />$
<br />I $
<br />- - -
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />_
<br />BODILY INJUR_CPeraccident)
<br />PROPERTY DAMAGE
<br />$
<br />- -
<br />(P er aeciden�
<br />$
<br />C
<br />UMBRELLA LIAB X OCCUR
<br />$
<br />X
<br />EXCESS LIAB CLAIMS -MADE
<br />AZ25EXC8463271C
<br />4/1/2025
<br />4/1/2026
<br />EACH OCCURRENCE
<br />51000,000
<br />$ -
<br />DED RETENTION $
<br />AGGREGATE
<br />- -- -
<br />$ - 5,000,000
<br />- _
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y / N
<br />X PER OTH
<br />STATUTE
<br />ANYPROPRIEroR/PARTNER/EXECUTIVE �
<br />MandatoryFFICER/Min ER EXCLUDED? -
<br />(Mandatory in NH)
<br />N /A I
<br />X
<br />ZAWC19430106
<br />I
<br />4/1/2025
<br />4/1/2026
<br />__ - - ER _
<br />E.L_EACH ACCIDENT �
<br />- _
<br />--- - --
<br />$--- 1,000,000
<br />_ -
<br />If yes, describe under
<br />I
<br />E.L. DISEASE- EA EMPLOYEE
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />_
<br />E. L. DISEASE -POLICY LIMIT I
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Pleasanton is an additional insured with primary wording per attached CG2010 0413 and CG2037 0413, primary wording applies per VEN05100 0220.
<br />General Liability waiver of subrogation applies per attached CG2404 0509. Auto Additional Insured applied per attached AC7005 0316. Work Comp Waiver of
<br />subrogation applies per attached
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Pleasanton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />123 Main Street ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Pleasanton, CA 94566
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|