Cupertino Symphonic Band-Certificate of Insurance- 2016ACORDATE
,,, CERTIFICATE OF LIABILITY INSURANCE
DD /VY)
04/28/16/28/16
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Northeast Agency Insurance Services
6467 Main Street -suite 104 Williamsville NY 14221
c/o Maryann Bettencourt Agency
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
20065 Stevens Creek Blvd, Suite#1 B Cupertino, CA 95014
0
INSURERS AFFORDING COVERAGE
INSURED
INSURER A: USLI
INSURER B: USLI
Cupertino Symphonic Band
PO Box 2692
INSURER C:
INSURER D:
Cupertino CA 95015
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH E 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 SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE POLICY NUMBER
POLICY EFFECTIVE
DATE MM/DD/VV
POLICY EXPIRATION
DATE MM/DD/VV
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1 ,000,000
FIRE DAMAGE (Any one fire)
$ 100,000
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE OCCUR NPP1567298
10/15/15
10/15/16
MED ExP (any one person)
$ 5,000
A
PERSONAL & ADV INJURY
$ 1 ,000,000
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP/OP AGG
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
BODILY INJURY
$
ALL OWNED AUTOS
B
SCHEDULED AUTOS
(Per person)
BODILY INJURY
$
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE
$
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS LIABILITY
EACH OCCURRENCE
$
AGGREGATE
$
OCCUR CLAIMS MADE
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU- OTH-
TORY LIMITSi ER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY LIMIT
$
OTHER
B
Directors and Officers NPP 1567298
10/15/2015 10/10/2016
500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Events April 30,2016 And June 2, 2016
CERTIFICATE HOLDER I X I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Additional Insured.
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
The City of Cupertino and their officers, employees,
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
representatives and agents.
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIV
ACORD 25-S (7/97) O ACORD CORPORATION 1988