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HomeMy WebLinkAbout296701 TIBURON INC - INSURANCE CERTIFICATE"✓ o CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) 02/13/2012 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 endomement(s). PRODUCER Aon Risk Insurance Services West, Inc. Los Angeles CA office CONTACT NAME: PHONE (866) 283-7122 IF (84]) 953-5390 (NC.W Ertl: aC. No.: EJWUL ADDRESS: 707 Wilshire Boulevard suite 2600 INSURER(S) AFFORDING COVERAGE NAIL e LOS Angeles CA 90017-0460 USA INSURED n A INSURER A: Federal Insurance Company 20281 Tiburon, Inc. P10 I 6200 stoneridge Nall Pleasanton CA 94588 USA INSURER e: Great Northern Insurance Co. 20303 INSURER C: Pacific indemnity Co 20346 INSURERM Continental Casualty Company 20443 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570045269057 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVO POLICY NUMBER MMIDO MMIDD UNITS A GENERAL LIABILITY EACH OCCURRENCE $1, 00F000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocaunenw $1, 000, 000 CLAIMS -MADE ❑X OCCUR MED EXP(Any one person) $10,000 PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000, 000 POLICY X PRO X FrT LOC B AUTOMOBILE LIABILITY 73558729 09/01/2011 0901 2012 COMBINED SINGLE LIMIT (Ed accident) $1, 000,000 BODILY INJURY( Per person) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident D X UMBRELLA LIM OCCUR L4030957581 09/01/2011 09/01/2012 EACH OCCURRENCE $10,000,000 EXCESS LIAR H CLAIMS -MADE AGGREGATE $10,000,000 DED RETENTION D WORKERS EMPLOYERS' COMPENSATION YIN ATION AND ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA 71739717 09/01/2011 09/01/2012 X VIC LIMBS ORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1.000,000 (Mandatory in NN) n yes, de nee unear DESCRIPTION OF OPERATIONS Below E.L. DISEASE -POLICY LIMB $1, 000, 000. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks schedule, n mare space is required) The city and county, their officers, officials, employees, agents, and volunteers are included as Additional Insureds regarding general liability as respects work performed by or on behalf of the named insured, as required by written contract. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's office AUTHORRED REPRESENTATIVE 300 Laporte Avenue Fyn P.O. Box 580 � ✓LAIC✓ L9A9[Lt6Pta c/IWW.4 /f p//� JL Fort Collins Co BOS22-0580 USA n N O ed NN uO YJ n N ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ACORO® CERTIFICATE OF PROPERTY INSURANCE oz/13/2012 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. If this certificate is being prepared for a party who has an Insurable interest in the property, do not use this form. Use ACORD 27 or ACORD 28. PRODUCER Ann Risk Insurance Services West, Inc. Los Angeles CA Office 707 Wilshire Boulevard suite 2600 LOS Angeles CA 90017-0460 USA CONVCT PHONE VAC No Exl1 CS66) 283-7122 FAX (84]) 953-5390 INC =E SS PRODUCER CuSTOMERIDN 57000005105E INSURERS AFFORDING COVERAGE NAIC e INSURED Tiburon, Inc. 6200 stoneridge Nall Pleasanton CA 94588 USA INSURERA: Federal Insurance Company 20281 INSURER B: INSURERC: ER D : :INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 57UU452b89/5 REVISION NUMBER: LOCATION OF PREMISES] DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional RamFb SO&c ule, H men apFp Is npul,Ml THIS IS TO CERTIFY THAT THE POUCIES 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 POLICY NUMBER POLICY EFFECTIVE DATE (MM/DONYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) COVERED PROPERTY LIMITS PROPERTY CAUSES OF LOSS DEDUCTIBLES BUILDING PERSONAL PROPERTY Bwlol Extra Expanse EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG 8 PP BASIC BUILDING BROAD SPECIAL CONTENTS EARTHQUAKE wlNe FLOOD A X INLAND MARINE OF LOSS NAMED PERILS All Risk TYPE OF POLICY IPStalltn Flotr 09/01/2011 09/01/2012 X Any Job Sne $5,0DBOOe CAUSES POLICY NUMBER 35911023 X CRIME TYPE OF POLICY BOILER 6 MACHINERY I EQUIPMENT BREAKDOWN SPECIAL CONDRIONS/OTHER COVERAGES (Attach ACORD 101, AddWonal RemarFa ScNedula, If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's office 300 Laporte Avenue P.O. Fort BOX SSD Collins CO 80522-0580 USAPM AUTHORIZED REPRESENTATIVE S/✓/�ILf/'f)-1,Js!/1 ,�L/J!/// © 1995-2009 ACORD CORPORATION. All rights reserved. ACORD 24 (2009/09) The ACORD name and logo are registered marks of ACORD x :lr