NNROK-Certificate of Insurance-2018POLICY
EXPIRATION DATE
100,000
BUSINESS INCOME
AUTHORIZED SIGNATURE
DAMAGE PREM RENTED TO YOU
GENERAL LIABILITY
LIMITSPOLICY
EFFECTIVE DATE
POLICY
NUMBER
TYPE OF
INSURANCE
INSR
LTR
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.
CERTIFICATE OF INSURANCE ISSUE DATE 4/18/2018
PRODUCER
Northeast Agency Insurance Services
6467 Main Street - Suite 104
Williamsville, NY 14221
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).
INSURER(S) AFFORDING COVERAGE
INSURER A:United States Liability Insurance Company
INSURER B:N/A
INSURER C:
INSURER D:United States Liability Insurance Company
INSURER E:N/A
COVERAGES
A
PERSONAL LIABILITY
NPP1567298B 10/10/2017 10/10/2018 GENERAL AGGREGATE
PRODUCTS-COM/OP AGG.
PERSONAL & ADV. INJURY
EACH OCCURRENCE
MED EXPENSE (Any one person)
1,000,000
Excluded
Included
500,000
Included
Included
B COMBINED SINGLE LIMIT
MEDICAL PAYMENTS TO OTHERS
EACH OCCURRENCE
AGGREGATE
each occurance
INSURED
C EXCESS LIABILITY
D
PROPERTYE BUILDING
CONTENTS
DESCRIPTION OF OPERATIONS / SPECIALTY ITEMS
Directors & Officers – Non Profit City of Cupertino
are named as additional insureds with respect to general liability.
CERTIFICATE HOLDER
City of Cupertino
10300 Torre Ave
Cupertino, CA 95014
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Abuse & Molestation NPP1567298B 10/10/2017 10/10/2018
Cupertino Symphonic
PO Box 2692
Cupertino, CA 95014
aggregate 300,000
NOTICE:
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED NONADMITTED”
OR “SURPLUS LINE” INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN
INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A
NON-UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK
QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR “SURPLUS
LINE” BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF
INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER:
1-800-927-4357. ASK WHETHER OR NOT THE INSURER IS LICENSED
AS A FOREIGN OR ON-UNITED STATES (ALIEN) INSURER AND FOR
ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO
CONTACT THE NAIC’S INTERNET WEB SITE AT WWW.NAIC.ORG
5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE
UNITED STATES AND YOU MAY CONTACT THAT STATE’S
DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION
ABOUT THAT INSURER.
6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER
SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED
STATES AND SHOULD BE ON THE NAIC’S INTERNATIONAL
INSURERS DEPARTMENT (IID) LISTING OF APPROVED
NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR
AGENT, BROKER, OR “SURPLUS LINE” BROKER TO OBTAIN
MORE INFORMATION ABOUT THAT INSURER.
7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE
INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON
THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF
THE CALIFORNIA DEPARTMENT OF INSURANCE:
WWW.INSURANCE.CA.GOV
8. IF YOU, AS THE APPLCIANT, REQUIRED THAT THE INSURANCE
POLICY YOU HAVE PU RCHASED BE BOUND IMMEDIATELY, EITHER
BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN
TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE
COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT
RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR
YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE,
YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS
OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE
PREMIUM WILL BE PRORATED AND ANY BROKER’S FEE CHARGED
FOR THIS INSURANCE WILL BE RETURNED TO YOU.
D-2 (Effective July 21, 2011)