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Certificate of Insurance - Senior Housing Solutionsr----•� SEN10-8 OP ID: SY ACORL7' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/14/2014 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 endorsement(s). PRODUCER Phone: 415-493-2500 CONTACT NAME: Farallone Pacific Insurance F415�93-2505 PHONE FAX Fax: Services, License# OF84441(AC.No Ext : (A/C, No): 859 Diablo Avenue E-MAIL Novato, CA 94947 ADDRESS: Daniel J. Costello INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nonprofits' Insurance Alliance INSURED Senior Housing Solutions INSURER B : North American Elite Marina Blanco 1400 Parkmoor Ave., Suite 190 INSURER C : San Jose, CA 95126 INSURER D : rnveDAnl=Q rl=0TICI1ATI= NI IMF21=R- RFVISI(1N NIIMRFR- TLJIv Iv TO yEp TiCV THAT TUE Ev L�lrilLv `. iR"SLR^^.".OE ��v _ ��-, 'L :ter Ei' .vv - �� �D - ` n �� , A - TO .INSURE NAMED ABOVE FOR THE POLICY rCf\I 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 ADD iLiL SUBS POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER (MMM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 2014-04083-NPO 03/01/2014 03/01/2015 DAMAGE TO RETE PREMISES Ea occur ence $ 500,00 CLAIMS -MADE 1XI OCCUR ! MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 $ POLICY PRO- LOC AUTOMOBILE LIABILITY OEaMBINED ccident SINGLE LIMIT (CEO, a $ 1� 000,00 A ANY AUTO 2014-04083-NPO 03/01 /2014 03/01 /2015 $ _ BODILY INJURY (Per person) BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS OOWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ AGGREGATE $ 1,000,00 A EXCESS LIAR CLAIMS -MADE 2014-04083-UMB , 03/01/2014 03/01/2015 DED I X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If ec, descrih ,nde, DESCRIPTION OF OPERATIONS below N / A I I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT- $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Campbell, its officers, agents, employees and volunteers are included as additional insureds, but only as respects to the operations of the named insured under written contract and as per CG2026 0704 attached IRE: 1120 Fairland Court, 201 Pollard Rd & 88 Llewellyn Ave., Campbell CA I � I CERTIFICATE HOLDER L;ANL;tLLAI IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. Sharon Teeter 70 North First St AUTHORIZED REPRESENTATIVE Campbell, CA 95008 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD