17-006 Lynn Fisher, Consultant Services for Content Services for New Website Roll-out (Insurance Info)DATE (MMtDDffYYY)
02/27/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONEERS 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
REPRESENT ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certifimte tiOlder ia an ADDITIONAL INSURED, ttie POl=V(ieS) must be endorsed. If SUBROGATION IS WAIVED, Rub)eat tO
the terms and COnditiOnS Of the policy, certain pOliCieS mad require an endorsement. A statement On thiS certificate dOeS net confer rights, tO the
certificate holder in lieu of such endorsement(s).
PRODUCER
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA
520 Madison Avenue
32nd Floor
NewYork, NY 10022
CONTACT
NAM!i:
I
I'l;gJlo'.Exti; (888)202-3007 5,hot:
iE-I
1 €
Ull
)Fl:Css: -contact@hiscox.com
INSURER(S) AFFORDING COVERAGE NAIC #
INSuRERA: HiscoxlnsuranceCompanylnc 10200
INSuRED
Lynn Fisher
2156 San Antonio Place
SantaClara CA 95051
INSURER B :
INSURER C :
INSuR!-R D :
INSURER E :
INSURER P :
COVERAGE!Th
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSLIED TO THE INSLIRED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQLIIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCLIMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE I:bSuE[) OR MAY PERTAI%. THE INSURANCE AFFORDED BY THg POLIC!ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLuSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDLICED BY PAID CLAIMS.
INaR
lTR TYPE OF INSURANCE g SuBR
M I POLICY NUMBER
POLICY E-PF
(MMtDD/YYYY)
POLICY EXP
(MMIDD/YYYY)LIMITS
A
x COMME:RCIAL GENERAL LIABILITY
ICIAIMS-MADE [EII occus i
I Y
I
UDC-191 8823-CGL-17 02/28/2017 02/28/2018
EACH OCCURRENCE ' s 2,000,000
DAhAAGE TO ReNTED
PREMISES (Ea txxiurrance)$ 100,000
MED EXP (Any one person)s 5,000
PERSONAL & ADV INJURY $0
GEN'L AGGREGATE LIMIT APPLIES PER:
_poo;Ec;,[II]r:gr[IIIIlcoc
GENERAL AGGREGATE $ 2,000,000
PRODuCTS - COMP/OP AGG 5 S/T Gen. Agg.
$
AU-aMOBllj_ ilABlilTY
ANY AUTO
ALL OWNED scheouieo_ AUTOS n AuTOS
II NON-OWNED____ HIRED AuTOS AUTOS
COMBINED SINGLE LIMIT
(ea acidenl)$
BODILY INJURY(Peru)$
BODILY INJURY (Persa)$
PROPERTYDAMAGE
(Per aocdenll $
$
LIMBR!LLA LIAB
EXCESS llAB
OCCUR
CLA1MS=MADE
!ACH OCCURRENCE $
AGGREGATE $
DED I I RETENT.ON $$
WORKERS COMPENSATION
AND EMPLOYERSa LIABILITY Y , N
"'€%:"o:"A'ff'u'oS"ffiEcUT'VE @(Mandatory in NH)
If yes, descnbe under
DESCRIPTION OF OPERATIONS below
N/A
12'nJTEI If-
E.l. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE$
!i.L. DISEAIE - POLICY LIMTT $
DESCRIPTION OF OPERAT10N8 / LOCATIONSIV!HICLES (ICORC lO'l, Additional Remarks ScheduJ may be attghed ff more space is requlrQ
The City Cupertino California are an additional insured.
CERTIFICATE HOLDER
The City Cupertino California
10300 Torre Ave
Cupertiho, C5 90524
I
SHOULD ANY OF THE ABOVE DE8CRIBED POljaE8 BE CANCEIIED BEFORE
THE EXPIRATION DATE THEREOF, NOTK:E Mu BE DELID IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AuTHORlZID Ft!iPRIS!iNTATlffl
ACORD 25 (2014/01)
eERTIFICAYE NUMBER:REVi810N NUMBER:
CANCELLATION
@ l0a840lA u:nf?n CClRF'OnATION. All dghts resanad.
The ACORD name and logo av reglstered marks ofACORD