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HomeMy WebLinkAboutCertificate of Liability InsuranceOP ID: PC ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE08/23D/YYYY) OB/23/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 626-405-8031 Chapman 626-405-0585 License #0522024 P. O. Box 5455 Pasadena, CA 91117-0455 CONTACT NAME: (Ale No. Ent): FAX No): E-MPL ADDRESS- CUSTOMER OLIVE-1 PRODUCER ID i{: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Olivewood Gardens and Learning Center DBA: International Community Foundation Center 2505 N. Avenue National City, CA 91950 INSURER A: Southern Insurance Company 19216 INSURER B : Nonprofits' Insurance Alliance NIAC INSURER C: INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: N THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AWL INSR SUER WVD POLICY NUMBER POLICY En IMMRIDWYYY) POLICY EXP (MMIDDNYYY) LIMITS B GENERAL X GEN'L —1 LIABILITY COMMERCIAL GENERAL 11 CLAIMS -MADE X LIABILITY OCCUR X 201026382NPO - 09/20/10 09/20/11 EACH OCCURRENCE $ 1,000,000 PREMISES ETOREN7ED PREMISES (Ea Occurrence) $ 500,000 MED EXP (My one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC PRODUCTS - COMP/OP AGG $ 3,000,000 $ AUTOMOBILE __ LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B UMBRELLA LMB EXCESS LIAR O OCCUR CLAIMS -MADE 201026382UMB 09/20/10 09/20/11 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 AGGREGATE X DEDUCTIBLE RETENTION $ 10,000 $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE Y/H OFFICERJMEMBER EXCLUDED? (Mandatory In NH) K yes describe under DESCRIPTION OF OPERATIONS below N /A W$1003064602 09/30/10 09/30/11 WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Re: Agreement. The City of National City,its elected officials, officers agents and employees are named additin insured with respect to the operations of the named Insured per the attached CG 2010 endorsement. Workers Compensation coverage excluded, evidence only. CERTIFICATE HOLDER CANCELLATION City of National City 1243 National City Blvd. National City, CA 91950 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 201026382NPO COMMERCIAL GENERAL LIABILITY CG20100704 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): The City of National City, its elected officials, officers, agents and employees Location(s) Of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. CG 2010 07 04 B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. © ISO Properties, Inc., 2004 Page 1 of 1 0