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HomeMy WebLinkAboutSLO Art Center Wrkrs Comp`�llAl� city o san^luis OB SPO uis June 11, 2007 Karen Kile Executive Director San Luis Obispo Art Center RE: Workers Compensation coverage San Luis Obispo Art Center Dear Ms. Kile: Our records indicate Workers Compensation coverage for the above referenced agreement expires as of July 1, 2007. Attached is the expiring certificate for your reference. The document may be faxed in advance to the number below, and then hard copies mailed. All documents should be sent to: City of San Luis Obispo Attn: City Clerk's Office 990 Palm Street San Luis Obispo, CA 93401 If you have any questions, please phone me at (805) 781 -7103. Our fax number is (805) 781 -7109. Sincerely, 4ulie O'Connor Deputy City Clerk GA704 -06 Agreements- Contracts\Utters for Insurance Certificates\2007 \SLO Art CenterInsurance Request Workers Comp.doc The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities. Telecommunications Device for the Deaf (805) 781 -7410. Number: 373- 0014416 -05 Date Entered: 7/18/2006 0-JR DATE (MM;DD;YYYY) A:�'�TM CERTIFICATE_C�2.__LIABIL. TY INSURANCE 7/18/2006 PRODUCER Manhattan Insurance Se vice , - -,7 __. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PO Box 720 ii ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Nipomo, CA 93444 i '! (;' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (805)929 -4104 :'! I._ L ? HK ;INSURERS AFFORDING COVERAGE NAIC # INSURED San Luis Obispo Art Center, Inc. INSURER A. National Liability and Fire Insurance Karen Kile INSURER B. ff PO �INSURERC. San BLuis Obispo, CA 93406 INSURER D: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADD'L I POLICY EFFECTIVE POLICY EXPIRATION. LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM DD YY DATE M DD Y LIMITS -I GENERAL LIABILITY j EACH OCCURRENCE $ �—' COMMERCIAL GENERAL LIABILITY I_ - DAMAGE TO RENTED .l "', PR.EMISES (Ea occurencel_ -- I $ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ ��� I GENERAL AGGREGATE i $ ---- -I GEN'L AGGREGATE LIMIT APPLIES PER: PRO- I � Pi RODUCTS - COMP /OP AGG I $ �— - - -- POLICY LOC AUTOMOBILE LIA131LITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS I BODILY INJURY $ F' SCHEDULED AUTOS (Per person) i ! HIRED AUTOS I BODILY INJURY 1 NON -OWNED AUTOS I j (Per accident) j $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT $ EA ACC OTHER THAN $ ANY AUTO : j AUTO ONLY: qGG _ 1 $ EXCESS /UMBRELLA LIABILITY j EACHOCCURRENCE $ ` OCCUR CLAIMS MADE _ I _ AGGREGATE $ I I DEDUCTIBLE - I -' $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- I OTH -, TORY LIMITS R -- - - -- -- - -T -- -- A EMPLOYERS' LIABILITYI ANY PROPRIETOR /PARTNER /EXECUTIVE 0100020734 -061 7/1/2006 I 7/l/2007 E.L. EACHACCIDEN ? —_` $ 1'000!_00_ OFFICER /MEMBER EXCLUDED? I E.L. DISEASE - EA EMPLOYEE[ $ 1, 000,000 If yes, describe under SPECIAL PROVISIONS below I E.L. DISEASE -POLICY LIMIT 1$ 1,000,000 OTHER I DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS City of San Luis Obispo is named as Additional Insured CERTIFICATE HOLDER City of San Luis Obispo 990 Palm Street San Luis Obispo, CA 93401 ACORD 25 (2001/08) Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing 800- 208 -1977 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN TAT IV ) ©.ACORD CORPORATION 1988