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<br />~~ ACORD
<br />~ CERTIFICATE OF LIABILITY INSURANCE I DA TE (MM/00/YYYYJ
<br />03/23/2023
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TH E CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXTEND OR A LTER THE COVERAGE AFFORDED B Y THE POLICIES
<br />BELOW. THIS CERTIF ICATE 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 o r be endorsed.
<br />If SUBROGATION IS WAIVED , subject to the terms and cond itions of the policy, certa in policies m ay requ ire an endorsement. A statement on
<br />th is certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />Jeffrey Stephens Insurance
<br />PO Box 93
<br />.. ___ __ INSURER(.§JAFFOROI NGCOVERAGE _ __ __ __ -~AIC• __
<br />Fairfax
<br />I NSURED
<br />___ C~4~~ ___ INS UR!;R A ": . N~rofits Insuran ce All iance of CA ·------~ _ _ _
<br />Tri Valley Haven for Women
<br />366 3 Pa cifi c Ave.
<br />Livermore
<br />COVERAGES CERTIFICATE NUMBER:
<br />94550
<br />INS URJ:~.o~ Ri ver lnsur~nce ~o. _ _. _____ . _!085~ __
<br />31194
<br />INSURE R E : ,----. ·-
<br />INSURE R F :
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO VE FOR THE POLICY PERIOD
<br />INDIC ATED. NOTWITHSTANDING ANY REQUIREMENT . TE RM OR CONDITION OF ANY CO TRACT OR OT HER DOCUME T WrTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSU ED OR MAY PERTAIN , THE IN SURANCE AFFORD::D BY THE PO LI CIES DES CRIBED HEREIN IS SUBJECT TO ALL THE TE RMS .
<br />EXCLUSIONS ANO CONDITIONS OF S CH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~::, TY PEOFINSURAN CE --l~_?;l_!-~~,.," -·--PO LICYNUMBER --· (~ai~b~ 1:~i~;--·--LIM ITS ----·-
<br />IX I COMMERCIAL GENERAL LI ABI LITY cACH occuRRE NCE $ 1 ,000 ,000 cs CLAI MS-MADE [?<l OCCUR PR~~~J?E~~~_;sc,MOo ____ _
<br />I
<br />I
<br />I
<br />X Profe ss ional Liability MED EXP ~yore person) $ 20,000
<br />' A L__i ___________ _
<br />I GEN"L AGGREGA TE LIM IT APPLIES PER
<br />iX 1 POLICY C j~ ~ LOC
<br />il OTHER .
<br />' AUTOM081 LE LIABILITY
<br />~ANYAUTO
<br />')( OWNED
<br />A !-c.-AU10SONLY
<br />1 X I ~:fr'g's ONLY r.
<br />,--, SCHEDULED
<br />fvl ~~~5WNED
<br />~J AUTOSONLY
<br />I
<br />X
<br />I X
<br />i
<br />~ UMBR EL LA U AB ~ OCCU R
<br />A I . EXC ES S U AB I CLAIMS-MADE X
<br />1 I OED : X : RETENTION$ 10,000
<br />1
<br />I WORKERS COM PENSATI ON
<br />'
<br />ANO EMPLOYERS" LIABI LITY y / N
<br />B ANY PROPRIETOR/PARTNER/EXECU TIVE r,:;-iN 'N / A
<br />I OFFICER/MEMBER EXCLUDED? ~ j
<br />(Mandato,y In NH )
<br />1
<br />11 yes . desa,be unde r
<br />DESCRIPTION OF OPERATIONS bel ow
<br />Dir ectors and Officers
<br />Cri me/Emp loyee Disho ne sty X
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<br />'
<br />'
<br />03720
<br />I
<br />03720
<br />I
<br />03720
<br />X TRW C42903 4 I
<br />I 10723308 1
<br />04/01/2023 04/01 /2 024 PE RSO N.AL~ ADV INJURY . $ 1,000,000
<br />..Q;~E~AL A~GREGAT_E ___ sc_2_,o_o_o~,o_o_o ____ -t
<br />P'lOOUCTS. COM" OP AGG $ 2 ,000,000
<br />$
<br />CO MBINED SIN GLE LIMIT $ 1 000 000 (Ea accldenl) ' _. -----.
<br />BODtl Y INJURY (Per J)<lrson ) $ '--~-------·-
<br />04/01/2023 04 ,0 1120 24 BODI LY IN JURY (PeraCCld4lntl $
<br />PROPER .. Y DAMAGE $----·--• , ll:'!!.1!.£!2!tnl L _ _ _ . ______ _
<br />,$
<br />_J:A~OC£YR~NCL_ __ _L_'l .000,000
<br />04/01/2023 04/01/2024 AGGREGA-E _____ $ 1 ,000 ,000 ___ _
<br />s x . ~~T.f ~i~H· ________ _
<br />0410112023
<br />1 Q4/0l/2024 E.L . EACH ACC IDEN T $ 1,0000 000 ____ .
<br />_ ~-L-DISEASE_·~ EMPLOY EE, $ 1,000 ,000
<br />E L. DISEASE • POLICY LIM IT
<br />04/01/2023 I 04/01/2024 Limit
<br />s 1,000 .000
<br />2 .000 .000
<br />300 ,000
<br />DESCRIPTION OF OPERATIO NS / LOCATIONS / VEHICLES (ACORD 101 , Add itional Remarks Schedule, may be att ached ii more spac e is required)
<br />Umbrell a Limits over CGL , Auto Li ab ili ty, Profess ional Li ab ility, and Directors and Officers Liabil ity.
<br />RE : Pleasan ton CD BG and Community Grants .
<br />The City of Pleasan ton , its official s , employees , ageents and volu nteers are named as ad ditio na l in sured .
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Pl easan to n
<br />SHOULD AN Y O F THE A BOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hou si ng Dd ivision , City Man ag er
<br />Attn : Stev e Hern andez
<br />PO Box 520
<br />Pleasanton
<br />ACORD 25 (2016/03)
<br />THE EXPIRATI ON DA TE THE REOF , NOTICE
<br />ACCORDANCE WIT H T HE POLICY PROVISIONS.
<br />AUTHORIZED REP RESENTATIV E
<br />C A 9456 6 08 02 ~ /I/
<br />-© 1988 2015 ACORD CORPORA
<br />The ACORD name and logo are registered marks of ACORD
<br />WILL BE DELIVERED IN
<br />TION. All ri hts reserved . g
<br />DocuSign Envelope ID: 90A4F4B9-16B7-4D23-8D35-C49CAD3CA273Docusign Envelope ID: 3A376F76-3AB3-4C95-B51C-233D2936A45A
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