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Certificate of Insurance - Rebuilding Together Silicon ValleyREBIJI-1 AcoRv CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDI �� 04/10/2015 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 CONTACT CalNonprofits Insurance Svcs NAME: Coryn Gardiner -- P.O. Box 640 a/CC,NN , Et►:831-824-5017 lac, Nol: 831-824-5057 Itola, CA 95010 EMAIL Ca — - - P ADDRESS: c0 n cal-insurance.org Coryn Gardiner INSURED Rebuilding Together Silicon Valley 1701 S. 7th St., Ste 10 San Jose, CA 95112 COVERAGES CERTIFICATE NUMBER! INSURER(S) AFFORDING COVERAGE INSURERA:State COmp Insurance Fund INSURER 8 : INSURER C : E: F REVISION NIIMBFR- 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. INSR LTR TYPE OF INSURANCE ADDL U POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD/YYYY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR i i EACH OCCURRENCE $ DAMAGERENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY j GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ $ $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F PRO LOC JECT _ $ AUTOMOBILE LIABILITY ANY AUTO ALTOS AUTOS L OWNED SCHEDULED Al NON -OWNED HIRED AUTOS AUTOS CEO�BIMBINEDtSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY AGE DAM PER ACCIDENT $ $ UMBRELLA LIAB EXCESS LIMB I OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A M WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN AN f I°r(GPKIE f VK/PAK 1 NEICIEiCEvU 1 PJE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 9+2F255 ?5 4a!0?!2015 04!0112016 X WC STATT- OTH- EAC I E.:.. �.. N O.CC.rJEDlT $ 1;OOn nn E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,000 i i IPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) certificate is provided for the purpose of verifying workers, sation coverage only. TE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN of Campbell ACCORDANCE WITH THE POLICY PROVISIONS. sing Coordinator orth First Street AUTHORIZED REPRESENTATIVE pbell, CA 95008-1458 / 1.1A r J, © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD .^,2me -nri I;•gc :ire reg stArsd mark,, of ACORD �..� REBUI-1 OP ID: qq AcoRO CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) kw---03/30/2016 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 CONTACT NAME:_ __ Coryn Gardiner ___ _ _. _ TFAx CalNonprofits Insurance Svcs PHONE P.O. Box 640 AUC No Ext): 831-824-5017 lac, No): 831-824-5057 Capitola, CA 95010 ADDRESS: coryn@cal-insurance.org Coryn Gardiner INSURER(5) AFFORDING COVERAGE NAIC t; INSURER A: State Comp Insurance Fund 35076 INSURED Rebuilding Together Silicon Valley 1701 S. 7th St., Ste 10 San Jose, CA 95112 INSURERS: INSURER C : INSURER D : INSURER E : COVERAGES CERTIFICATE NUMBER: 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. � TYPE OF INSURANCE POLICY NUMBER MMIDDIWYY MM/D hWY LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I ! OCCUR EACH OCCURRENCE $ O RENT PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ _ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJEC LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ;OMBINED SINGLE LIMIT ANY AUTO BODILY INJURY (Per person) $ ALL OWNED F—] SCHEDULED BODILY INJURY (Per accident) AUTOS $ AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB I�---jl CLAIMS -MADE AGGREGATE WORKERS COMPENSATION X w� a i/ i u- u i -- AND EMPLOYERS' LIABILITY T RY LIMIT ER Y I N A ANY PROPRIETOR/PARTNER/EXECUTIVE 9126965-16 W0112016 0"1/2017 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED, ❑ N /A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 00 If yes, describe under _----._----- -- DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This certificate is provided for the purpose of verifying workers, compensation coverage only. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN tY P ACCORDANCE WITH THE POLICY PROVISIONS. Housing Coordinator 70 North First Street AUTHORIZED REPRESENTATIVE Campbell, CA 95008-1458 / ©1988-2010 ACORD CORPORATION. All rights reserved. (2010/05) The ACORD name and logo are registered marks of ACORD