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HomeMy WebLinkAboutCertificate of Liability Insurance (Effective Dates: 9/22/11 to 9/22/12)—� uI 10: I td .4CC1Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 09/06/11 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(les) 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 856-452-2200 NME Nateridge Insurance Services 858 452-8004 PHONE FAX 10717 Sorrento Valley Rd. AMYL . Ewe: WC, No): San Diego, CA 92121 1.B. Guy Insurance Agency,Inc. PPRODUc CUSTOMER ID e: NCCHAMI INSURED National City Chamber of Commerce; Mile of Cars Assoc. 901 National City Boulevard National City, CA 91950 INSURER(S) AFFORDING COVERAGE INSURER A : Assurance Company of America INSURER B : NAIC 0 19305 INSURER C: INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. NTR TYPE OF INSURANCE ADDL INSR SUER )Wa. POLICY NUMBER POLICY EFT (MMIDDIYYYY). POLICY EXP (MMNDWYYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X PAS38912516 09/22/11 09/22/12 EACH OCCURRENCE $ 2,000,000 X pRal$Es(EeENTTrcence) . $ 2,000,000 CLAIMS -MADE X MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY , $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GENL AGGREGATE LIMIT APPLIES PER: , PRODUCTS - COMP/OP AGG $ 4,000,000 )( POLICY [ jRLO& 1 1 LOC $ A - AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS MIRED AUTOS NON -OWNED AUTOS PAS38912516 09/22/11 09/22/12 COMBINED SINGLE LIMIT ( Ea $ 1,000,000 BOODILYDILYINJURY NJURY(Per person) : J $ BODILY INJURY (Per accident) ' $ PROPERTY DAMAGE (Per accident) $ X X $ $ UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE . EACH OCCURRENCE $ — AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? Ifyes, despite under DESCRIPTION OF OPERATIONS YIN N/A - WC STATU- - OTH- TORY LIMITS I FR E.L. EACH ACCIDENT $ ❑ E.L. DISEASE - EA EMPLOYEE $ below E.L. DISEASE -POLICY LIMIT $ )ESCRIPTION OF OPERATIONS / LOCATIONS IVEHICLES 'HE CITY OF NATIONAL CITY ITS OFF )GENTS AND CONTRACTORS, AS THEIR IDDITIONAL INSURED W/RESPECT TO 1E:NAMED INSURED'S SIGNS LOCATED (Attach ACORD 101, Additional Remarks Schedule CIALS BOARDS, COMMISSIONS, EMPLOYS RESPECTIVE INTERESTS MAY APPEAR GENERAL LIABILITY PER ATTACHED IN THE CITY LIMITS OF NATIONAL CITY If more space Is required) ARE NAMED CG2012 05/09. 7.ERTIFICATE HOLDER CANCELLATION NATI 002 CITY OF NATIONAL CITY 1243 NATIONAL CITY BLVD. NATIONAL CITY, CA 92050 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 meerS 4� WORD 25 (2009/09) 01988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo a e registered marks of ACORD } National City Chamber of l,Jimerce POLICY NUMBER: PAS38912516 COMMERCIAL GENERAL LIABILITY CG 20 12 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required by Written".Contract, Agreement or Permit Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or au- thorization. 2. This insurance does not apply to: a. "Bodily injury.", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". CG 2012 05 09 Q Insurance Services Office, Inc., 2008 Page 1 of 1 a NOTEPAD INSUREDS NAME National City Chamber of NCCHAMI OP ID: TB PAGE 2 DATE 09/06/11 ***NAMED INSURED SCHEDULE READS AS FOLLOWS: NATIONAL CITY CHAMBER OF COMMERCE MILE OF CARS ASSOCIATION OP ID: TB A��.,a. �F CERTIFICATE OF LIABILITY INSURANCE DATE(i06/11 Y) 09l06H 7 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 poilcy(les) 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), 'RODUCER 858.452-2200 Vateridge Insurance Services 0717 Sorrento Valley Rd. 858-452-6004 :an Diego, CA 92121 LB. Guy Insurance Agency,Inc. LCT car PHONE . FAX NC. No. Exll: INC, No): PRODUCER caste MER ID a: NCCHAMI INSURERS) AFFORDING COVERAGE NACU NSUKED National City Chamber of Commerce; Mile of Cars Assoc. 901 National City Boulevard National City, CA 91950 INSURER A :Assurance Company of America _19305 INSURER B : INSURER C: INSURER D : INSURER E: INSURER F: ;OVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. .TR TYPE OF INSURANCE ADD�U NUMBER POLIPOLICY / WRIOTIYYYYI { IWODNYYYY1 LIMITS k GENERAL UABILITY COMMERCIAL GENERAL LIABILITY X X PAS38912516 09/22/11 09/22112 EACH OCCURRENCE $ 2,000,000 X PREMGE i ISES RENTwErenCel $ 2,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one preen) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 EN•L AGGREGATEILIMIT APPLIESI�PER: GGEP) PRODUCTS-COMP/OP AGO. $ 4,000,000 FAT A l POLICY 7 1 128f I LOG $ k AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PAS38912516 09/22111 09/22/12 COMBINED SINGLE LIMIT (Eeacradenq $ 1,000,000 — BODILY INJURY (Per person) $ BODILY INJURY(Peraccident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ UMBRELLA LIAB EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS YIN N/A 1 WC STATU- I OTH- TORY LIMITS I FR E.L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ below EL DISEASE - POLICY LIMIT $ IESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, AddItlonal Remarks Schedule EE ATTACHED NOTEPAD FOR ADDIT ONAL INFORMATION AND FULL NAMED CHEDULEC RE: NAMED INSURED'S USAGE OF FACILITIES AT NAVAL BASE ALIFORNIA; CONTRACT #N6247308RP00015 If mere apace Is required) INSURED SAN DIEGO, ,ERTIFICATE HOLDER CANCELLATION DEPARTMENT OF THE NAVY SOUTHWEST DIVISION NAVFAC ENGINEERING COMMAND 1220 PACIFIC HIGHWAY BAN DIEGO CA 92132 DEPT00_ 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 CORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSUREDS NAME National City Chamber of NCCHAMI PACE 2 OP ID: TB DATE 09/06/11 "'NAMED INSURED SCHEDULE READS AS FOLLOWS: NATIONAL CITY CHAMBER OF COMMERCE MILE OF CARS ASSOCIATION NOTEPAD: HOLDER CODE DEPTOO_ INSURER'S NAME National City Chamber of NCCHAMI OP ID: TB PAGE 3 DATE 09/06/11 THEN E RE OF AMERICA CT TO PEERRp TIF SA OR F OADDED AS T THE TE INSURED WITH RE P CT Tv O T O TOR ) iS ADDE PRE�,M! ES SUBROGAATION GAINSMT7H EUUN ITEDDSTTATESggO�pF AMESi AyyWHR HICH MIGH�{T ANY immix R ��OSOFATI PENGINT MADEUOMMA_[DISOUT WESTSONMANDINCALIFORNIA,b AIY gN L NgFqCGI AN A{IRTY tJGINEER NG u DE n 71 ML �p tO pUNDER MHATE�RIIAL CyHAsIGh T.1 F CANALL at SD W TIO HE NAME P INKY*** LOA SSjI'N�E NYPRUA7 TpHE DIRECTION OpF THE VVgER�p�Sgaff g�{ALL BE PAYABLE TO THE NAMED INSUREb AN OF THE UNITED STATED OF AMERICA" �NySURED SHALL. BE PAYABLE TO THE TREASURER NATIONAL CITY CHSCHEDULE COMM RCEREADS AS FOLLOWS: MILE OF CARS ASSOCIATION National City Chamber of obmmerce POLICY NUMBER: PAS38912516 COMMERCIAL GENERAL LIABILITY CG20120509 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: As Required by Written'. Contract, Agreement or Permit Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to opera- tions performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or au- thorization. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". CG 2012 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 C7