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Certificate of Insurance - Sacred Heart Community ServiceA�oi2o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYYY) /Y 1/28/2016 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 endorsements . PRODUCER Arthur J. Gallagher Co. Insurance Brokers off CA. Inc. LIC # 0726293 505 N Brand Blvd, Suite 600 CONTACT NAME: Michelle Gonzalez FA P"oNE 818-539-2300 XC. . 818-539-2301 E-MAIL s: Michelle_Blelen@ajg.com INSURE AFFORDING COVERAGE NAIC0 Glendale CA 91203 INSURER A: Riverport Insurance Company 36684 INSURED INSURERS: New York Marine And General Insuran 16608 Sacred Heart Community Service 1381 South First St. San Jose, CA 95110 INSURER C : INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1738459775 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. INSR L72 TYPE OF INSURANCE N POLICY NUMBER POLICY EFF MID POLICY EXP DIYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR ProfLiab $3m/$1m Y RIC0014890 1/30/2016 1/30/2017 EACH OCCURRENCE $1,000,000 GE TO RENT PREMISES Ea occurrence) $100,000 X MED EXP (Any one person) $5,000 X AbusUab $3m/$1m PERSONAL & ADV INJURY $1,000,000 L AGGREGATE LIMIT APPLIES PER: JETPO- LOC GENERAL AGGREGATE $3,000,000POLICY N'OTHER: PRODUCTS - COMP/OP AGG $1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL8ED AUTO�gULED NONX HIRED AUTOS X AAUTOS AUTOS RIC0014890 1/30/2016 1/30(2017 COMBINED SINCIETWIlr— Ea accident $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) E Per accident $ $ A UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE RELOO14891 1/30/2016 1/30/2017 EACH OCCURRENCE E3,000,000 X AGGREGATE $3,000,000 DED I X I RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE — OFFICEWMEMBER EXCLUDED? (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below NIA WC201500006323 7/1/2015 7/1/2016 X I STATUTE 1 17 ER E.L. EACH ACCIDENT $1,000,000 E1,000,000 E1,000,000 E.L. DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT A Crime Coverage RIC0014890 1/30/2016 1/30/2017 Limit $445,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) Certificate holder is hereby included as an additional insured but only as their interest may appear with respects to the operations of the named insured. Workers compensation coverage excluded, evidence only. Endorsement to follow CERTIFICATE HOLDER CANCELLATION City of Campbell Community Development Dept. 70 N. First Street Campbell CA 95008 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ACC> ® DATE (MMIDD/YYYY) V CERTIFICATE OF LIABILITY INSURANCE 7/5/2016 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 endorsements . PRODUCER CONTACT MNAMEichelle Gonzalez Arthur J. Gallagher Co. PHONE . 818-539-2300 Fax No). 818-539-2301 Insurance Brokers off CA. Inc. LIC # 0726293 E-MAIL Michelle_Bielen@a com 505 N Brand Blvd, Suite 600 1g Glendale CA 91203 INSURER(S) AFFORDING COVERAGE NAIC r INSURER A: New York Marine And General Insuran 16608 INSURED INSURER B Sacred Heart Community Service INSURERC: 1381 South First St. San Jose, CA 95110 INSURERD: E: rnAIVDA _rc CrDTlrl!`err IuluuQen. 7AA414720 DVI/Mi 1111 KII IRAQVD- 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR WVD POLICY NUMBER Y COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ O RENTED PREMISES Ea occurrence) f MED EXP (Any one person) $ PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL BSWNED ASUHTEDULED HIRED AUTOS NON -OWNED AUTOS Ea accident)S BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ Per accident) S S UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED I I RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under SC DERIPTION OF OPERATIONS below N �A WC201600006323 7/1/2016 7/1/2017 X PE OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT 1 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Evidence of Coverage. CERTIFICATE HOLDER CANCELLATION City of Campbell Community Development Dept, 70 N. First Street Campbell CA 95008 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. USA AUTHORIZED REPRESENTATIVE 11 ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE (M ACoO16 (MM/DD/YYYY) R ® CERTIFICATE OF LIABILITY INSURANCE 7/5/20 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 endorsements . PRODUCER CONTACT NAME: Michelle Gonzalez Arthur J. Gallagher & Co. PHONE g18-539-2300 FAX 818-539-2301 Insurance Brokers of CA. Inc. LIC # 0726293 E-MAIL 505 N Brand Blvd, Suite 600 Michelle_Bielen@ajg.com Glendale CA 91203 immocorst accnonlwa rnvcoar-c Nair INSURED Sacred Heart Community Service 1381 South First St. San Jose, CA 95110 A_ Riverport Insurance Company B:New York Marine And General Insuran INSURER D : rnrnil=Rar:Fc rFDTICIr_aTG wuuaGD• 2097336063 DCVIe1nu 1111111AQCD- 6608 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. ILTR TYPE OF INSURANCE ) POLICY NUMBER POLICY EFF PWDfYYrr LIMITS A X COMMERCIAL GENERAL LIABILITY X� OCCUR Prof $3mm/$1 mm Y RIC0014890 1/30/2016 1/30/2017 EACH OCCURRENCE $1,000,000 DAMCLAIMS-MADE PREMISES $100,000 X MED EXP (Anyone person) $5,000 X AbusLiab $3m/$1m PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO JECT 7 LOC OTHER: GENERAL AGGREGATE $3,000,000 PRODUCTS --COMP/OP AGG $1,000,000 f A AUTOMOBILE LIABILITY ANY AUTO Ab� OWNED SUHEDULED HIRED AUTOS X ANOIN--OSWNED AUTOS RIC0014890 1/30/2016 1/30/2017 Ea accident) f 1,000,000 X BODILY INJURY (Per person) f BODILY INJURY (Per accident) f X Per accident f f A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE RELOO14891 1/30/2016 1/30/2017 EACH OCCURRENCE $3,000.000 X AGGREGATE f3,000,000 DIED I X I RETENTION SO $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC201600006323 7/1/2016 7/1/2017 X PER EOTH - STATUTE R E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 E.L. DISEASE - POLICY LIMIT A Crime Coverage RIC0014890 1/30/2016 [1/30/2017 Limit $445,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is hereby included as an additional insured but only as their interest may appear with respects to the operations of the named insured. Workers compensation coverage excluded, evidence only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Campbell THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 70 N. First Street Campbell CA 95008 USA AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RIC0014890 RIVERPORT INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY BROADENING ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Throughout this endorsement, the words "you" and "your" refer to the Named Insured shown in the Declarations. The word "we," "us," and "our" refer to the company providing this insurance. The following is only a summary of the additional coverages provided by this endorsement and is provided only for your reference and convenience. For the Limits of Insurance and the additional coverages provided by this endorsement, read the provisions on the following pages and the Coverage Form, which this endorsement modifies. SUBJECTS OF INSURANCE Broadened Bodily Injury Broadened Personal and Advertising Injury Broadened Property Damage Broadened Fire, Lightning, Explosion, and Sprinkler Leakage - $500,000 Broadened Medical Payments - $10,000 Broadened Supplementary Benefits a. Bail Bonds - $1,000 b. Expenses Incurred to Assist in Defense - $500 per Day Broadened Newly Acquired or Formed Organization Broadened Non -Owned or Chartered Watercraft or Aircraft Broadened Commercial General Liability Conditions a. Duties in the Event of Occurrence, Offense, Claim, or Suit b. Liberalization — Automatic Coverage If We Adopt Broader Coverages c. Notice to Company Automatic Coverage for "Special Events" Automatic Additional Insureds a. Athletic Activity Participants b. Contractual Obligations c. Funding Sources d. Manager or Lessor of Premises e. Owner, Manager, Operator, or Lessor of "Special Event" Premises f. Supervisors or Higher in Rank — Co -Employee Exclusion Removed g. Limitations Blanket Waiver of Subrogation Priority of Application for Multiple Insureds The coverages listed in this endorsement are provided as extensions or additions to your insurance program. RPCG 74 12 08 05 Page 1 of 7 Includes copyrighted material of Insurance Services Office, Inc , with its permission POLICY NUMBER: RIC0014890 RIVERPORT INSURANCE COMPANY described in Paragraph (b) (i) or SECTION IV - COMMERCIAL GENERAL (b) (ii) above. LIABILITY CONDITIONS (c) "Property damage" to property: Item 8. is replaced with: (i) owned, occupied or used by; or 8. Transfer of Rights Of Recovery Against (ii) rented to, in the care, custody, or Others To Us And Blanket Waiver Of control of, or over which physical Subrogation control is being exercised for any a. If an insured has rights to recover all or part of purpose by: any payment we have made under this you, any of your "employees," any Coverage Part, those rights are transferred to partner, or member (if you are a us. The insured must do nothing after loss to partnership or joint venture), or impair them. At our request, the insured will any member (if you are a limited bring "suit" or transfer those rights to us and liability company), help us enforce them. g. Additional Insured - LIMITATIONS b. If required by written "insured contract," we (1) The persons, entities, or organizations to waive any right of recovery we may have which coverage is extended under against any person or organization because of Paragraphs a. (Athletic Activity payments we make for injury or damage arising "your Participants), b. (Contractual Obligations), out of your ongoing operations or work" c. (Funding Sources), d. (Managers or done under a contract for that person or organization and included in the "products - Lessors of Premises), and e. (Owner, completed operations hazard." Manager, Operator, or Lessor of "Special Events' Premises) are Additional Insureds, 13. PRIORITY OF APPLICATION FOR MULTIPLE but only: INSUREDS (a) With respect to each Additional SECTION III - LIMITS OF INSURANCE Insured's vicarious liability for "actual This Section is amended to add the following paragraph: damages" solely caused by you or by 8. In the event a claim or "suit" is brought against more "your work" that is ongoing for such than one insured, due to "bodily injury" or "property Additional Insured's supervision of damage" from the same "occurrence," or "personal "your work"; and injury," or "advertising injury," from the same (b) If the Additional Insured did not cause offense, we will apply the Limits of Insurance in the or contribute to the "occurrence" or following order: act resulting in liability. a. You; (2) If an endorsement is attached to this policy b. Your "executive officers," directors, and specifically names a person or "employees," and organization as an Additional Insured, then c. Any other insureds in any order that we the coverage extended under this choose. paragraph 4. AUTOMATIC ADDITIONAL INSURED(S) does not apply to that person, entity, or organization. ALL OTHER TERMS AND CONDITIONS (3) SECTION V - DEFINITIONS, REMAIN UNCHANGED. This section is amended to add the following Item 24: 24. "Actual Damages" is to have its usual and customary legal meaning and excludes without limitation, punitive damages, restitution, penalties, and formula damages added to "actual damages" and any other enhanced damages. (4) All other terms and conditions of this Coverage Part which are not inconsistent with this Paragraph h. apply to coverage extended to the above referenced Additional Insureds REGARDLESS OF WHETHER OR NOT A COPY OF THIS COVERAGE PART AND/OR ITS ENDORSEMENTS ARE DELIVERED TO AN ADDITIONAL INSURED. 12. BLANKET WAIVER OF SUBROGRATION RPCG 7412 08 05 Page 7 of 7 Includes copyrighted material of Insurance Services Office, Inc., with its permission.