Laserfiche WebLink
ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />INSR ADDL SUBR <br />LTR INSD WVD <br />PRODUCER CONTACT <br />NAME: <br />FAXPHONE <br />(A/C, No):(A/C, No, Ext): <br />E-MAIL <br />ADDRESS: <br />INSURER A : <br />INSURED INSURER B : <br />INSURER C : <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) <br />AUTOMOBILE LIABILITY <br />UMBRELLA LIAB <br />EXCESS LIAB <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE $ <br />DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ <br />PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT <br />OTHER:$ <br />COMBINED SINGLE LIMIT <br />$(Ea accident) <br />ANY AUTO BODILY INJURY (Per person) $ <br />OWNED SCHEDULED <br />BODILY INJURY (Per accident) $AUTOS ONLY AUTOS <br />HIRED NON-OWNED PROPERTY DAMAGE <br />$AUTOS ONLY AUTOS ONLY <br />(Per accident) <br />$ <br />OCCUR EACH OCCURRENCE <br />CLAIMS-MADE AGGREGATE $ <br />DED RETENTION $ <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />COMMERCIAL GENERAL LIABILITY <br />Y / N <br />N / A <br />(Mandatory in NH) <br />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 />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 />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 />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: <br />CERTIFICATE HOLDER CANCELLATION <br />© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />$ <br />$ <br />$ <br />$ <br />$ <br />The ACORD name and logo are registered marks of ACORD <br />8/15/2024 <br />License # 0757776 <br />01184 <br />Eden Council for Hope & Opportunity (ECHO) <br />22551 Second Street, Rm 200 <br />Hayward, CA 94541 <br />29874 <br />A 1,000,000 <br />X X <br />2023-01679 10/28/2023 10/28/2024 <br />500,000 <br />20,000 <br />1,000,000 <br />3,000,000 <br />3,000,000 <br />1,000,000A <br />2023-01679 10/28/2023 10/28/2024 <br />1,000,000A <br />2023-01679-UMB 10/28/2023 10/28/2024 <br />1,000,000 <br />A Directors & Officers 2023-01679-DO-NPO 10/28/2023 Aggregate Limit 1,000,000 <br />B Cyber/Privacy/Networ C4MQ8280103CYBER-2023 12/8/2023 12/8/2024 Aggregate 1,000,000 <br />Revised 8-15-2024 This certificate rescinds and supersedes any and all prior certificates issued on behalf of the Named Insured. <br />Re: Contract <br />City of Pleasanton is included as additional insured under the general liability policy, additional insured coverage applies when required by written contract <br />per policy form # CG 20 26 12 19. Waiver of Subrogation with regard to General Liability applies when required by written contract per policy form # NIAC-E26 <br />11 17. <br />City of Pleasanton Economic Dev/Housing <br />PO Box 520 <br />Pleasanton, CA 94566 <br />EDENCOU-03 SSALAZAR <br />HUB International Insurance Services Inc. <br />40 E Alamar Ave <br />Santa Barbara, CA 93105 <br />Trosalyn Allen <br />trosalyn.allen@hubinternational.com <br />Nonprofits' Insurance Alliance of California, Inc <br />Swiss Re Corporate Solutions America Insurance Corporation <br />Aggregate <br />10/28/2024 <br />X <br />X <br />X <br />X X <br />X X <br />Docusign Envelope ID: F53F1E05-ADA3-465D-BE20-156E055217E3