SAFETY DRIVER'S ED 2 - 2013 - Laserfiche WebLink

Home Browse Search

rl'nnil. A951117 QCIT_VIA1.1=011] 1.1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATe(MM20112 11/01/2012 THIS CERTIFICATE IS ISSUED ASA 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). PRODUCER CONTACT NAME: PHONE 770 476-1770 Alc, Nal: 770 476-3651 A1C No Ext: J. Smith Lanier & Co. -Atlanta 11330 Lakefield Drive Bldg 1, Suite 100 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Duluth, GA 30097 INSURERA: Philadelphia Indemnity Insuranc 18058 INSURED Henry Ramirez dba Bay Area Driving; Driving School Safety Drivers -Ed I 1070 A. Street Hayward, CA 94541 INSURER B: INSURER C INSURER D - INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBLK: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDLSUBR NSR WVO POLICYNUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY PHPK779435 11/01/201211101/201 EACC�HgqOCCCTURRENCE $1,000000 PREMISESOEa oNT11 ce $100000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $5000 CLAIMS-MADEEj� OCCUR PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGRE�GA�TE PER', PRODUCTS - COMP/OP AGG $2,000,000 $ pLIMITAPPL�IEIS POLICY JEOT LOC A AUTOMOBILE LIABILITY PHPK779435 11/01/2012 11/01/2.01 COMBINED SINGLE LIMIT Ea oddedo $500,000 BODILY INJURY (Per Person) $ X ANY AUTO BODILY INJURY(Peraccident) $ X ALL OWNED BCHED ULEC AUTOS AUTOB NON -OWNED HIRED AUTOS X AUTOS -- PROPERTY DAMAGE $ Per accidenU _ UMBRELLA LIABOCCUR I EACH OCCURRENCE__ $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory, in NH) NIA WCSTAMULT - OTH- T ITS E E, L. EACH ACCT DENT $ E.L. DISEASE - EA EMPLOYEE $ E. L. DISEASE -POLICY LIMIT $ f yes, describe under DESCRIPTION OF OPERATIONS below A Building PHPK779435 11/01/2012 11101/201 $357,000 Personal Property $30,000 DESCRIPTION OF OPERATIONS) LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) To FORM LISA E° . ey ant City Attofn *For Information Purposes Only* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACr1Rn On RPn RATIOKI All rinhta racnrvad ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1704512/M1704508 TXA