|
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />6/20/2025
<br />Edgewood Partners Insurance Center
<br />P.O.Box 2110
<br />Rancho Cordova CA 95670
<br />Kelly Phillips
<br />916-358-8024 916-583-7613
<br />kelly.phillips@epicbrokers.com
<br />License#:0B29370 BETA Healthcare Group Risk Management A
<br />AXISCOMM Federal Insurance Company 20281AxisCommunityHealth,Inc.
<br />5925 West Las Positas Blvd Suite 100
<br />Pleasanton CA 94588
<br />CFC Underwriting 22276
<br />690606501
<br />A X 4,000,000
<br />X 500,000
<br />5,000
<br />5,000,000
<br />5,000,000
<br />X
<br />HCL251064 7/1/2025 7/1/2026
<br />Included
<br />A 2,000,000
<br />X X
<br />AL251064 7/1/2025 7/1/2026
<br />A XWC2510647/1/2025 7/1/2026
<br />2,000,000
<br />2,000,000
<br />2,000,000
<br />B
<br />A
<br />C
<br />Crime -Employee Theft
<br />Professional Liability RD 5/01/77
<br />Cyber Liability
<br />82553413
<br />HCL251064
<br />ESO0140394811
<br />7/1/2025
<br />7/1/2025
<br />7/1/2025
<br />7/1/2026
<br />7/1/2026
<br />7/1/2026
<br />Limit:$400,000
<br />Each Claim $4,000,000
<br />Agg:$5,000,000
<br />Retention:$2,000
<br />Agg:$5,000,000
<br />Deduct:$10,000
<br />Excess Worker's Compensation,Carrier:Safety National Casualty Corporation,NAIC #15105,Policy #SP4066651,Term:07/01/25-07/01/26,Statutory Limits
<br />Excess of $1,000,000.
<br />Re:All Contracts/Written Agreements between the Certificate Holder and the Insured.Additional Insured:City of Pleasanton,its officials,employees,agents
<br />and volunteers.When required by written contract,additional insured status with primary coverage and waiver of subrogation apply to General Liability and
<br />Workers'Compensation,all per the attached endorsements.
<br />City of Pleasanton,its officials,employees,agents and
<br />volunteers
<br />PO Box 520
<br />Pleasanton CA 94566
<br />Docusign Envelope ID: 1FF54D60-4FAC-4FF9-AE01-6E4CA6FCC839
|