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HomeMy WebLinkAboutCertificate (5).pdf DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �� 10/10/2023 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 CONTACT NAME: Stephanie Powell Arthur J. Gallagher Risk Management Services, LLC aHONNo Ext: 818-539-1366 FAX No:818-539-1666 500 N. Brand Boulevard Suite 100 ADDRESS: Stephanie_Powell@ajg.com Glendale CA 91203 INSURER(S)AFFORDING COVERAGE NAIC# License#:OD69293 INSURERA:American Zurich Insurance Company 40142 INSURED ANTHINC-02 INSURER B:Zurich American Insurance Company 16535 Elevance Health, Inc. and Its Subsidiaries 2015 Staples Mill Road INsuRERc: National Union Fire Insurance Company of Pittsburg19445 Mail Drop VA2001-N350 INSURERD:Great American Security Insurance Co 31135 Richmond VA 23230 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1385971623 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY B X COMMERCIAL GENERAL LIABILITY Y Y GLO 0853238-01 5/1/2023 5/1/2024 EACH OCCURRENCE $2,000,000 Fv� DAMAGE TO CLAIMS-MADE OCCUR PREMISES ('a a oNcur ence) $1,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $25,000,000 X POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: Per Occurence Ded $2,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $3,000,000 BAP 0853239-01 5/1/2023 5/1/2024 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Per Accident Ded $3,000,000 D X UMBRELLA LIAB X OCCUR LIMB 4370303 5/1/2023 5/1/2024 EACH OCCURRENCE $25,000,000 C 14121685 5/1/2023 5/1/2024 EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 DED X RETENTION$In nnn $ A WORKERS COMPENSATION Y WC9299269-22 1/1/2023 1/1/2024 X PER OTH- B AND EMPLOYERS'LIABILITY STATUTE ER Y/N EWS5347154-18 1/1/2023 1/1/2024 B ANYPROPRIETOR/PARTNER/EXECUTIVE WC9376766-21 1/1/2023 1/1/2024 E.L.EACH ACCIDENT $2,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Subject to policy terms,conditions and exclusions. RE: REF Agreement No.23-266 County of Fresno,its officers,agents,and employees is included as Additional Insured,per form CG 20 10 12 19,when required by written contract for General Liability arising out of the operations of the Named Insured.The insurance provided in the General Liability policy is primary and any other insurance shall be excess only,and not contributing.Waiver of Subrogation applies to certificate holder,as respects General Liability and Workers Compensation policies, pursuant to and subject to the policy's terms,definitions,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN County of Fresno ACCORDANCE WITH THE POLICY PROVISIONS. Department of Behavioral Health, Contracts Division-SUD Services 3133 N. Millbrook Avenue AUTHORIZED REPRESENTATIVE Fresno CA 93703 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GLO 0853238-01 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization that the insured has agreed by written contract or written agreement to name as an Additional Insured and executed prior to the occurrence of any loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or required by a contract or agreement, the organization(s) shown in the Schedule, but only insurance afforded to such additional insured with respect to liability for "bodily injury", "property will not be broader than that which you are damage" or "personal and advertising injury" required by the contract or agreement to caused, in whole or in part, by: provide for such additional insured. 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 3 Wolters Kluwer Financial Services, Inc. I Uniform Forms B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of 3 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 C. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following is added to insurance; Section III — Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable limits of insurance. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 3 of 3 Elevance Health,Inc and its Subsidiaries. GLO 0853238-01 Eff. 05-01-23 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 Wolters Kluwer Financial Services, Inc. I Uniform Forms WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS OR ORGANIZATIONS . WC 00 03 13 (Ed. 4-84) ©1983 National Council on Compensation Insurance.