HomeMy WebLinkAboutCertificate of InsuranceAlcownr CERTIFICATE OF LIABILITY INSURANCE.
DATE3IDC1'YYY)
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 LOCKTON COMPANIES,LLC-K CHICAGO
525 W. Monroe, Suite 600
CHICAGO IL 60661
(312) 669-6900
Nr. TACT Lockton Companies, LLC
PHONE 1-800-921-3172 FPS 1-312-681-6769
No Ex�L�(atc, nol:
E-MAIL
ADDRESS; Rotarylockton.com
1NauRER{S) AFFORDING COVERAGE
NAIL'S
: ACE American Insurance Company
22667
ENSUREDINSURSRA
All Active US Rotary Clubs & Districts
Attn: Risk Management Division
1560 Sherman Ave.
Evanston, IL 60201-3698
INSURER B ; ACE Prgpeity & Casualty Insurance C4
21699
INSURER C :
INSURER0:
INSURER E.:
INSURER F ;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER;OD
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 HEREN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.
IL SR
TYPE OF INSURANCE
SUER WUD
POLICY NUMBUZ
POLICY EFF
fMMJ➢DJYYYYj_{MMIDDJYYYYjV
YOUCY ER?
LIMns
A
GEAfERALLIABILITY
(OMMERCIALGEEIERAL��n.rtY
I CLAIMS -MADE O UR
N
EMI G23861355 004
7/1/2012
7/1/20033
EACH OCCURRENCE
s 2,000,000
S 500,000
DAMAGX
PRESIS 70REHTur
PR��I�>�;� a��l>�)
MEDEXF{Any one person)
S XXXXXXX
X
Liquor LiabilitF
.PERSONALS ADM INJURY
$ 2,000,000
Included
GENERAL AGGREGATE
$ l0 0D0.000
Gait AGGREGATE LIMIT APPUESPER:
LCC
naorY,JC75-COMPICPAGO
$ 4,000,000
3
A
AUTOMOBILELJABILITY
X
A
ANY AUTO
ALL CANNED
X
J
SCHEDULED
N
P I G23B61355 004
7/1/2012
7%i/2013
2 jtyINGLE`M
$ l 000,D00
BODILY INJURY {Per person)
$ XXXXXX;,
$ X XVC)CX
BODILY INJURY (Per
{ }
PROPERIYOAMAGE
rPeryQcidntt
$ �
wXXXX
$ X)ti,n..t x
B
X
uitea>Lwuas
EXCESS LIAB
X
occult
CLAIMS -MADE
N
?9DG534092 004
7/1/2012
7/1/2013
EACH.00c:URRENCE
,$ 5,{}00,000
$ 10 000,000
$ XXXOCa:
AGGREGATE
CEO
1 RETENTION $
WORKERS COMPENSATION
ANDEfdPLOYERS LIABILITY
ANY PRCFRIETORIPARTNERJEXECU TIME
OFFIG_R MEMBER EXCLUDED?
(Mandat Iv In NH)
F 3.dascnOunder'
YIN
N!A
NOT APPLICABLE
WOSTArU- 0TH-
TORYL111IT. l ER
E L CU EACH ACDENT
$ x�Xx
$ ){0 [X
EL DISEASE- SA EMPLOYEE
E.L. DISEASE- POLICY LIMIT
$ XXX
.X
l
DESCRIPTION OF OPERATIONS f LOCAT,ONS f VEHICLES (Attach ACORD 101, Additional Rorsarke Schedule, if rnore space is regui:ed}
The Certificate Holder is included as Additional Insured where required by written and signed contract or
permit subject to the terms and conditions of the General Liability policy, but only to the extent bodily injury or
property damage is caused in whole or in part by the acts or omissions of the insured.
CANCELLATION
The City of National City, its officials, agents, and employees
Public Works Department
2100 Hoover Avenue
National City, CA 91950
Rotary Club District 5340/National City Rotary Club
For use of the Martin Luther King Community Center for
weekly luncheon meetings.
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 (2010/05)
The ACORD name and ! ogn are reg'stered marts of ACORD
Ct71988,21140 AGOf ORPbR7� 10N. All rights reserved