YMCA OF ORANGE COUNTY - Laserfiche WebLink

Home

ACRD® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 5/13/2016 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 endorsements). PRODUCER Belton & Company 3475 E. Foothill Blvd. Suite 100 ' Pasadena, CA 91107 www.boltonco.com 0008309 CONTACT NAME: PHONE FAX (A/C, No Ext : 626 799 -7000 (A/C, No): 626 583 -2117 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA : Philadelphia Indemnity 18058 INSURED YMCA of Orange County 1 3821 Newport Avenue Suite 200 Tustin CA 92780 INSURER B: California Ins. Co. 38865 INSURER C ,, INSURER D: 3/1/2016 INSURER E: EACH OCCURRENCE INSURER F: COVERAGES CERTIFICATE NUMBER: 29905743 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYY LIMITS A COMMERCIAL GENERAL LIABILITY ,, ,, PH PK1459740 3/1/2016 3/1/2017 EACH OCCURRENCE $ 1 ,000,000 CLAIMS -MADE OCCUR FV/1 DAMAGE TO RENTED PREMISES Ea occurrence $ 1 ,000,000 MED EXP (Any one person) $ 20,000 Includes Sexual Abuse Coverage PERSONAL & ADV INJURY $ 1 ,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-] PRO JECT F-] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY PH PK1459740 3/1/2016 3/1/2017 COMBINED SINGLE LIMIT Ea accident $ 1 XO X0 BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB ,/ OCCUR PHUB531685 3/1/2016 3/1/2017 EACH OCCURRENCE $ 1510001000 AGGREGATE $ 1510001000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y 1 N OFFICERIMEMBEREXCLUDED? N/A 738670330104 3/1/2016 3/1/2017 �/ STATUTE OTT ER E.L. EACH ACCIDENT $ 1 ,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL Additional Insured & Waiver of Subrogatio apply per GL PI- GLD -HS 10 -11 attached, only if required by written contract/agreement. GL Primary & Non - Contributory Wording applies per PIGL0051011 attached. Cancellation clause applies per IL02700811 attached. Re: Use of Various Facilities. Additional Insured(s): City of Riverside, and its officers, employees and agents. Additional I nsu red (s): CERTIFICATE HOLDER CANCELLATION City f Riverside Parks, Recreation and Community y y Services Department Attn: PRCSD Designee - Aquatics SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 3900 Main Street AUTHORIZED REPRESENTATIVE Riverside CA 92522 Joyce Ferguson ©'1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 29905743 1 16 GL AUTO EXCESS WC I Nancy Cadwallader 1 5/13/2016 12:02:31 PM (PDT) I Page 1 of 18