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ANY PROPRIETOR/PARTN ER/EXECUTIVE
<br />O FFICER/MEMBER EXCLUDED?
<br />ADD L SUBRINSR
<br />LT R INSD WVD
<br />DATE (M M /D D /YY Y Y )
<br />C ON TACTPRODUCERNAME:
<br />FAXPHONE(A /C,No):(A /C,N o,Ext):
<br />E-M AIL
<br />ADD R ESS:
<br />IN SURER A :
<br />IN SURED IN SURER B :
<br />IN SURER C :
<br />IN SURER D :
<br />IN SURER E :
<br />IN SURER F :
<br />POLIC Y EFF POLIC Y EXPTYPEOFINSURANCE LIM ITSPOLICYNUMBER(M M /DD /Y YY Y )(M M /DD /Y YY Y )
<br />AU T OM O BILE LIAB ILITY
<br />U M BR ELLA LIAB
<br />EXCESS LIAB
<br />W OR KERS CO M PENSATION
<br />AN D EMPLO Y ERS'LIAB ILITY
<br />D ESCRIPTIO N OF O PERAT ION S /LOC AT ION S /VEHIC LES (A C O RD 10 1,Additi onal Remarks Sche dule,m ay be atta ched if m ore s pace is require d)
<br />AUT HO RIZED R EPRESENTATIVE
<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 AGG $JECT
<br />$OTHER:
<br />COMBINED SINGLE LIMIT $(Ea accident)
<br />ANY AUTO BODILY INJURY (Per person)$
<br />OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOSHIREDNON-OWNED PROPERTY DAMAGE $(Per accident)AUTOS ONLY AUTOS ONLY
<br />$
<br />EACH OCCURRENCE $OCCUR
<br />CLAIMS-MADE AGGREGATE $
<br />$DED RETENTION $
<br />PER OTH-STATUTE ER
<br />E.L.EACH ACCIDENT $
<br />E.L.DISEASE -EA EMPLOYEE $
<br />If yes,describe under E.L.DISEASE -POLICY LIMIT $DESCRIPTION OF OPERATIONS below
<br />INSURER(S)AFFORDING COVERAGE NAIC #
<br />COMMERCIAL GENERAL LIABILITY
<br />Y /N
<br />N /A
<br />(Mandatory in NH)
<br />SH O ULD ANY O F THE ABO VE DESC RIBED PO LICIES BE CANC EL LED B EF OR E
<br />TH E EXPI R ATION DATE THER EO F ,N OTICE W ILL BE DEL IVER ED IN
<br />ACCO RD AN CE W ITH THE PO L IC Y PR O VI SI ON S.
<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 />T HIS C ERT IFICATE IS ISSUED AS A MATTER O F INFO RMATIO N ON LY AN D C ON FERS NO R IGHTS U PON TH E CERTIFIC ATE HO L DER.TH IS
<br />CERTIF IC ATE D O ES N OT AF F IR MATIVELY O R N EGAT IVELY AMEND ,EXTEND O R ALTER THE C OVERAGE AFFORD ED B Y TH E POLICIES
<br />BELO W .TH IS C ERTIFICATE O F INSUR AN C E D O ES N OT C ON STIT UTE A CO N T RACT B ETW EEN TH E ISSUIN G INSUR ER(S),AU T HO RIZED
<br />REPRESENT ATIVE OR PROD U C ER,AN D TH E C ERTIFIC ATE HO L DER.
<br />IMPORTANT:If th e certi fi cate holder is an AD DITIO NAL IN SUR ED,th e policy(i e s)m us t h ave ADD IT ION AL INSUR ED provisions or be endorsed.
<br />If SUB R O GAT ION IS WAIVED,s u b je ct to th e te rm s and c onditi ons o f th e p o licy,certa in p o licies m ay require an endorsem ent.A sta te m ent o n
<br />th is ce rti fi c ate does not confe r rights to th e certi fi cate hold er in lie u of s uch endorsem e nt(s ).
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2015 ACORD CORPORATION.All rights reserved.
<br />The ACORD name and logo are registe red marks of ACORDACORD25(2016/03)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />Policy Number:
<br />PO Box 1613
<br />Pleasanton, CA 94566
<br />Allen Insurance
<br />185 Front Street, Ste. 204
<br />Danville, CA 94526
<br />(925)820-9090
<br />Date Entered:
<br />(925)820-9028
<br />CityServe of the Tri-Valley
<br />9/02/2025
<br />A NPP1616019B 01/26/2025 01/26/2026
<br />3,000,000
<br />Excluded
<br />Excluded
<br />1,000,000
<br />100,000
<br />5,000
<br />1,000,000
<br />A NPP1616019B 01/26/2025 01/26/2026
<br />A
<br />CUP1581803 06/30/2025 06/30/2026
<br />1,000,000
<br />1,000,000
<br />B EIG 4602416 05 09/07/2025 09/07/2026 1,000,000
<br />1,000,000
<br />1,000,000
<br />The City of Pleasanton, its officers, officials, employees and designated volunteers are to be covered
<br />as insureds in respects to liability arising out of activities performed by or on behalf of City Serve of
<br />The City of Pleasanton
<br />PO Box 520
<br />Pleasanton, CA 94566
<br />R. Casey Allen
<br />25895
<br />11512
<br />29530
<br />9/2/2025
<br />the Tri-Valley.
<br />LN Mendez [email protected]
<br />A Professional E&O Liab NPP1616019B 01/26/2025 01/26/2026 $1,000,000
<br />$3,000,000
<br />E&O Ea Incident
<br />E&O Aggregate
<br />C Cyber Liability C4MQ8624133CYBER202508/22/2025 08/22/2026 $1,000,000Aggregate
<br />United States Liability Insurance Co
<br />Employers Preferred Ins Co
<br />Coalition Insurance Solutions Inc
<br />Docusign Envelope ID: E7B3E5BA-CB45-4196-BD8A-44D93DC64FA1
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