Paddy Wagon-Certificate of Insurance- 2018���amrfseal>;i��rara:Id��d
. 6. O CERTIFICATE OF LIABILITY INSURANCE
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DAM 04/02/2018n
04/02I2018
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER License # OD04026
CT
Roe
PHP Insurance Services, Inc.
1818 Tully Rd. Ste 162A
San Jose, CA 96122
PHONE FAX
a/c, Nu, Eat): (408) 528-1528 Alc Ne :(408) 528-9988
MASS.
INSURERS AFFORDING COVERAGE
NAIC N
INSURER A: Ma fre Insurance Company
23876
INSURED
INSURERS: United Financial Casualty Co.
11770
INSURER C: National Union Fire Insurance of PittsburgPA
World Wide Chasers Inc IDEA Paddy Wagon Sliders
INSURER D:
544 Hassinger Rd
San Jose, CA 96111
INSURER E:
INSURER F:
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 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
LTRA
TYPE OF INSURANCE
ADDLSUBR
POLICY NUMBER
POLICYEFF
POLICY EXP
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
X
8009030000218
11/1012017
1111012018
EACH OCCURRENCE
1,000,000
$
DAMAGE TO RENTED
$ 100,000
MED EXP An one arson
$ 10,000
PERSONAL& ADV INJURY
$ 1,000,000
GEN'L
X
AGGREGATE LIMIT APPLIES PER:
POLICY j LOC
OTHER:
GENERAL AGGREGATE
S 2,000,000
PRODUCTS-COMP/OPAGG
$ 2,000,000
$
B
AUTOMOBILE
LIABILITY
ANYAUTO
OWNED X SCHEDULED
AUTOS ONLY AUpTOSDSWN�p
AUTO& ONLY AUTOS ONLY
06126757-0
0412812017
0412812018
COMBINEDSINGLE LIMIT
$ 1,000,000
BODILY INJURY Per arson
$
BODILY INJURY Peracad.ru
$
Waiddent 'Nu1AGE
$
Comp/Coll Ded
$ 1,000
C
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
EBU061180564
0511012017
0611012018
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$ 1,000,000
DEC) I I RETENTIONS
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
AOpFFICEWMEIETOERFXCWDEOIECUTIVE ❑
(Mantlatory In NH)
If yes, describe under
DE SCRIPTION OF OPERATIONS below
NIA
IPER OTH.
E.L. EACH ACCIDENT
S
E.L. DISEASE -EA EMPLOYEE
S
E.L. DISEASE -POLICY LIMIT
S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if mom space Is required)
The City of Cupertino and their officers, employees, representatives and agents are named as additional insured.
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
ACORD 25 (20191031
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
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The ACORD name and logo are registered marks of ACORD