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Home My WebLink About296701 TIBURON INC - INSURANCE CERTIFICATE (2)°L �® CERTIFICATE OF LIABILITY INSURANCE DATE(M,=,ZYYY) Dw1 OD14 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. N SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorsement. A statement an 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 707 Wilshire Boulevard Suite 2600 CONTACT NAME: PHONE (g66) 283-7122 FAX 800-363-0105 lac No. Earl: Arc. N..: E41AIL ADDRESS: INSURER(5) AFFORDING COVERAGE NAICY LOS Angeles CA 90017-0460 USA INSURED INSURER A Pacific Indemnity Co 20346 Tiburon. Inc. 3000 Executive Parkway, Suite 500 San Ramon CA 94583 USA INSURER B: Federal Insurance Company 20281 Can an INSURER c: Continental casualty Company 20443 INSURER D: INSURER E: INSURER F: 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 am as requested INSR TR TYPE OF INSURANCE INSD INVID POLICY NUMBER LICIEFF FOUCYEXP M LIMR8 B X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑OCCUR PREMISES Ea ocwrrvr. S1,000,000 MEDEXP(Anyone,,emon) S10,000 PERSONAL B ADV INJURY S1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S2,000,000 PRO- ❑X LOC POLICY ❑X JEC PRODUCTS - COMPIOP AGO $2,000,000 OTHER 4-' - - a AUTOMOBILE LAIR -MY 7355-87-29 09/01/2014 09/01/2015 COMBINED SINGLE LIMIT E1,000,000 BODILY INJURY(Per,.n) ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED NAUTOS BODILY INJURY (Per axidenl) PROPERTYDAMAGE Par acdtlanl C X UMBRELLA LAB X OCCUR L4030957581 09/01/2014 09/01/2015 EACH OCCURRENCE S10,000,000 EXCESS LAB CLMMS4MADE AGGREGATE S10,000,000 DEO IRETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARRIERIEXECInNE N OFFICEROAEMBER EXCLUDED' NIA A 71739717 09 Ol 014 09/01 201 PER OTH- X STATUTE E.L EACH ACCIDENT $1,000,000 E. L. DISEASE -EA EMPLOYEE S1,000,000 (Mandatory in NH) If deemlee nnde, DE5CRIPTION OF OPERATIONS... E. L DISEASE.POLICY LIMIT S1,000,006. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, A4dlSonal R..&. SCKedule, may W atbclw41t moro apace N re9ulrod) 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. CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIAnON DATE THEREOF, NOTICE WILL BE DEWERED IN ACCORDANCE MR THE POUCYPROWSIONS. City Clerk's Office 300 Laporte Avenue AUTNORD]:O REPRESENTATIVE P.O. Box Fort Collinsns CO 80522-0580 USA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACORL� CERTIFICATE OF PROPERTY INSURANCE I DATE 09/12/2014 YYYY) 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. N this certificate Is being prepared for a party who has an insurable interest in the property, do not use this form. Usa ACORD 27 or ACORD 28. PRODUCER COMAC! ADn Risk Insurance Services West, Inc. LOS Angeles CA officeINC,. 707 Wilshire Boulevard Suite 2600 LOS Angeles CA 90017-0460 USA y C 9 P NE (866) 283-7122 800-363-0105 No. EtlL WC. No.l: E RILSS -PROOLICER CUSTOMERIDa: 570000051058 INSURERIS) AFFORDING COVERAGE NAIc a INSURED Tiburon, Inc. 3000 Executive Parkway, Suite 500 INSURER A: Federal Insurance Company 20281 W o INSURER B: INSURER. 1 INSURER D: San Ramon CA 94583 USA NSURER E: INSURER F: LOCATION OF PREMISEW DESCRIPNON OF PROPERTY (M h ACORD 101, Mdllionel Remed:e S[Mdule, H men span N,aqulM) 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. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YYYY) POLICY EXPIRATION ATE (MMND/YYYY) COVERED PROPERTY LIMBS A X PROPERTY55911023 CAUSES OF LOSS DEDUCTIBLES 09 1 14 09/01/2015 BUILDING PERSONAL PROPERTY BUSINESS INCOME EXIRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKETPERSPROP BLANKETP BLDG a P BASIC BUILDING BROAD SPECIAL CONTENTS EARTHQUAKE WIND X 51,000,000 FLOOD X ALL RISKSubjea W EAhomne X I BM PP Gad $30, 000 ARX X INLAND MARINE OF LOSS NAMED PERILS Al Risk TYPE OF POLICY Contractors EDP 09/01/2014 09/01/2015 X S uhd Equipment Stl Mull Equlp,nem S257,500 CAUSES P 591NUMBER 3591101023 X $101" CRIME TYPE OF POLICY BOILER A MACHINERY / EQUIPMENT BREAHOOWN rFcIILL CONDITIONS I OTHER COVERAGES (Attach ACORD 101, M4M.iii Remark. SCbeduN. If more a,.. Is rqulyd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WNH THE POLICYPROVISIONS. City Clerk's Office 300 Laporte Avenue AUiHONIZFD REPRESENTATIVE Ll/l/nLy')b�IF�/1 A R,'A(461PRS 4ET4� P.D. BOX5BD Fort Collins CO 80522-0580 USA 01995-2009 ACORD CORPORATION. All rights reserved. ACORD 24 (2009/091 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC 0: ADDITIONAL REMARKS SCHEDULE 570000051058 Page _ of _ AGENCY NAMED INSURED ADD Risk insurance services west, Inc. Tiburon, Inc. POLICYNUMBER See Certificate Number: S70055110813 CARRIER MAC CODE EFFECTIVE DATE: See Certificate Number: 570055110813 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 24 FORM TITLE: Certificate of Property Insurance INSURERS) AFFORDIN G COVERAGE NAIC # INSURERINSURERINSURERINSURER ACORD 10113008/01) 0I008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD