|
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 />6/11/2025
<br />Marsh &McLennan Agency LLC
<br />505 Broadway North,Suite 100
<br />Fargo ND 58102
<br />Josie Trnka
<br />701-237-3311 701-232-4442
<br />Josie.Trnka@MarshMMA.com
<br />Travelers Property Casualty Co of Amer 25674
<br />EIDEBAILL2 Great American Insurance Company 16691EideBaillyLLP
<br />PO Box 2545
<br />Fargo ND 58103
<br />Phoenix Insurance Company 25623
<br />Travelers Indemnity Company 25658
<br />1254917576
<br />C X 1,000,000
<br />X 300,000
<br />X 0 5,000
<br />1,000,000
<br />2,000,000
<br />X
<br />Y Y P6307206X385 4/29/2025 4/29/2026
<br />2,000,000
<br />D 1,000,000
<br />X X
<br />Y Y BA8M663607 4/29/2025 4/29/2026
<br />A X X 15,000,000YCUP2J9611894/29/2025Y 4/29/2026
<br />15,000,000
<br />A XYUB9L19981A4/29/2025 4/29/2026
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />B Employee Theft and
<br />Dishonesty SAAE8403190300 4/29/2025 4/29/2026 Limit
<br />Ded
<br />$5,000,000
<br />$25,000
<br />Workers Compensation applies to:AR,AL,AZ,AK,CA,CO,DC,DL,FL,GA,HI,IA,ID,IL,IN,KS,LA,MA,MD,ME,MI,MN,MO,MS,MT,NC,NE,NH,NJ,
<br />NM,NV,NY,OK,OR,PA,RI,SC,SD,TN,TX,UT,VA,VT,WI &WV
<br />Workers Compensation policy excludes Owners/Partners.
<br />Employers Liability applies to above states and ND,OH,WA,WY
<br />Zero Deductible for Auto Liability coverage.Hired Auto Physical Damage Deductible Comp/Coll Ded is $500/$500
<br />The City,its officers,employees,and agents are included as an additional insured on a primary and non-contributory basis on general liability policy including
<br />ongoing and completed operations coverage when required by written contract.Additional Insured status on a primary and non-contributory basis and waiver of
<br />subrogation also apply on the auto liability and umbrella policies.Waiver of subrogation applies on the workers compensation policy.Per the cancellation clause
<br />contained in the policies noted on this certificate,the policy provisions include at least 30 days notice of cancellation except for non-payment of premium.
<br />City of Pleasanton
<br />P.O.Box 520
<br />Pleasanton CA 94566
<br />Docusign Envelope ID: 4D8D057E-4488-45E9-BA32-D570041D40D0
|