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HomeMy WebLinkAboutCOI - City of Diamond BarClient#- 1RA2995 STUDETRA2 ACORD, CERTIFICATE OF LIABILITY INSURANCE O 6128/2/ODIVYVYI 1/28/2024 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER I NAME: T Oanh Nuyen Me. Ext): 610-897-4419 AIC, No: _ USI Insurance Services LLC 1787 Sentry Pkwy W., Veva 16 E-MAIL nu oanh.nuyen@usi.com Y Suite 300 ADDRESS: �:. INSURER($) AFFORDING COVERAGE NAIC N Blue Bell, PA 19422 National Interstate Insurance Company INSURER A: P Y 32620 INSURED INSURER B: Lexington Insurance Company 19437 Santa Barbara Transportation Corp. INSURER c: United Specialty Insurance Company 12537 7394 Calle Real, Ste H INSURER D : ACE Property & Casualty Insurance Co 20699 Goleta, CA 93117 Vanliner Insurance Company INSURER E : P Y 21172 INSURER I: LIOyW-of London SURPLU 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 CONTRACTOR 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. INRR TYPE OF INSURANCE NSB WVD POLICY NUMBER MMDUY� MMIDU� LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMSMADE OCCUR STAOOOOOO119 7/01/202407101/2025 EACH $5000000 �OCCURRENCE PREMIBES Ea oiconence $1 1 0001 000 MED EXP (Any one person) $10 000 PERSONAL &ADV INJURY $5,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER POLICY E JECCT LOG OTHER: GENERAL AGGREGATE $5,000,000 PRODUCTS-COMP/OPAGG $5,000,000 $ A A A A AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY AUTOSULED HIRED ONLY X NON -OWNED AUTOS ONLY STA000000119 STH000000119 STA000000219 STX000000219 'STXOOOOOO119 029316406 BTM2422077 7/01/2024 7/01/2024 7/0112024 7/0112024 07/011202 07/011202 07/01/202 07/01/202 COMBINED SINGLE LIMIT Ea aoddeot 5,000,000 X X BODILY INJURY (Per person) $ BODILY INJURY(Paracc,d.nt) S $ PROPERTY DAMAGE Per accitlent $ A B C X X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 7/0112024 7/01/2024 0710112024 07/01/202 07101/202 0710112025 EACH OCCURRENCE $20J _0_00J 000 $20OOO OOO AGGREGATE DED RETENTIONS sSee Remarks E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N OFRCERIMEMBER EXCLUDED? [N] (Mandatory in NH) es. desculde under DIf ESCRIPTION OF OPERATIONS but.. NIA SWC034149722 7/01/2024 07/01/2025 X PER OTH- E.L. EACH ACCIDENT S7000,000 E.L. EMPLOYEE $1,000:000 -DISEASE-EA E L. DISEASE- POLICY LIMIT $1:000,000 F F Sexual A&M (AOS) Sexual A&M (CA) MR244142 MR244143 7101/2024 7101/2024 07/01/202 07/01/202 $1,000,000 $10,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Evidence of Coverage ** Excess Liability Information ** B 029316406 Eff Date: 07101/2024 Exp Date: 07/0112025 (See Attached Descriptions) City of Diamond Bar Attn: Andee Williams 21810 Copley Drive Diamond Bar. CA 91765 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 ACORD 25 (2016/03) 1 of 2 #845316390/M45286971 ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CACZP DESCRIPTIONS (Continued from Page 1) 1 Excess Liability Each Occ Limit: $2,500,000 plo $5,000,000 in excess of $5,000,000 C BTM2422077 Eff Date: 07/0112024 Exp Date: 0710112025 Excess Liability Each Occ Limit: $2,500,000 plo $5,000,000 in excess of $5,000,000 D XEUG715414OA006 Eff Date: 07/01/2024 Exp Date: 07/01/2025 Excess Liability Each Occ Limit: $10,000,000 in excess of $10,000,000 ** Auto Liability Information ** A STH000000119 Eff Date: 0710112024 Exp Date: 07/0112025 (New Jersey Only) Combined Single Limit: 5,000,000 APD Limit: $5,000,000; Deductibles: $250,000 Comp/Coll A STA000000219 Eff Date: 07/01/2024 Exp Date: 07101/2025 (New Hampshire Only) Combined Single Limit: 100,000 A STX000000219 Eff Date: 07/01/2024 Exp Date: 07/01/2025 Limit: $4,900,000 in excess of $100,000 RE: Transportation Services Provided by the Named Insured The City of Diamond Bar, its officers, employees, agents and volunteers are included as Additional Insured under General and Auto Liability on a Primary and Non -Contributory basis as required by written contract with respect to work performed by the Named Insured. Waiver of Subrogation is included in favor of the Certificate Holder as respects Workers' Compensation where required by written contract. SAGITTA 25.3 (2016/03) 2 of 2 #S45316390/M45286971