Loading...
HomeMy WebLinkAboutParking Agreement to Blood Systems InsuranceACORD.. CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) I I/l/2017 10/18/2016 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,cLia the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer of such endorsement(s). PRODUCER Lockton Companies CONTACT NAME! - FM (AfC, No Ext): Arc No I. 8110 E. Union Avenu Suite 700 Denver CO (303) 414-6000 OCT q 8 2016 LDO E-MAIL N IC N INSURER A: Sell')nsured Retention INSURED Blood Systems, Ine. 1361621 dba United Blood ServicesSLO C 6210 East Oak Street i CL�[ Scottsdale, AZ 85257 INSURER 8 : Sentry Insurance a Mutual Com an hf- A*V 24988 INSURER C : Sentry Casualty Company X✓ 28460 INSURER 0 Lex ln &ion Insurance Com an V lei 19437 INSURER CLAIMS -MADE OCCUR INSURER F COVERAGES CERTIFICATE NUMBER: 12672616 REVISION NUMBER: XXXXXXX 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. 1NSR TYPE OF INSURANCE ADDL NSID DB POLICY NUMBER POLICDY EFF POLICY EXPIm LIMITS A X COMMERCIAL GENERAL LIABILITY N N Self Insured Retention 11/1/2016 11/1/2017 EACH OCCURRENCE s 1,000.000 CLAIMS -MADE OCCUR PRAEAGETO RENTED XXXXXXX MED EXP (Any oneperson) XXXXXXX X Prof Liab Clm51Jv ade PERSONAL & ADV INJURY $ XXXXXXX $I M each incident GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PEC LOC GENERAL AGGREGATE $ XXXXXXX PRODUCTS - COMP/OP AGG $ XXXXXXX $ OTHER: B AUTOMOBILE LIABILITY N N 90-04101-02 11/1/2016 11/1/2017 = SINGLE LIMIT $ 1.000,000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO AUTOS ONLY SCHEDULED BODILY INJURY (Per accident $ XXXXXXX AUTOS ONLY AUUTOS ONLDY Perr accide DAMAGE $ XXXXXXX $XXXXXXX D UMBRELLA LIAR X OCCUR N N 00314693 11/1/2016 11/l/2017 EACH OCCURRENCE $ $ 000,000 X EXCESS LIAR X CLAIMS -MADE AGGREGATE $ 5,000,000 DED RETENTION $ $ XXXXXXX C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN OFFIANYPROPRIETORIPARTNER/EXCER/MEM EREXCLUDED?ECUTIVE 7N (Mandatory in NH) Ir yes, describe under DESCRIPTION OF OPERATIONS below N/A N 900410101 AOS 900410104 (AZ, MD, WI) 11/1/2016 11/1/2016 11/1/2017 11/1/201'] X STASTATUTE OTH- IE.L EACH ACCIDENT $ 1000000.n !1 E L DISEASE - EA EMPLOYEE 1,000.000 E L. DISEASE -POLICY IIMIT 1,000.00 D GL/AL/EL-Occ Prof. Liab.-CM N N 00314693 11/1/2016 11/1/2017 $5,000,000 Aggregate $5,000,000 Each Incident Retro Date 1-1-02 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *Actual limits may be greater than those shown. Re: Lease requirements for property at SLO City Yard, San Luis Obispo, CA. Parking for United Blood Services blood bank bus. City of San Luis Obispo is Additional Insured as respects General and Auto Liability. L;tK I It`I4A I t MULULK UA NUr-LLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12672616 AUTHORIZED REPRESENTATIVE City of San Luis Obispo Attn: Deputy City Clerk 990 Palm Street San Luis Obispo CA 93401 fIC I'1 C r�►l ACORD 25 (2016/03) @198812015 ACORD CORPONATION. All rights reserved The ACORD name and logo are registered marks of ACORD RECEMMl) NOV 02 20 ACORD,,, CERTIFICATE OF LIABILITY INSURA qp C_' ~' 4 _ DATE(MM/DD/Y YY) 10/21/2015 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). PRODUCER Lockton Companies 8110 E. Union Avenue Suite 700 Denver CO 80237 ONTACT NAM A/c No, Ext): Arc No): EMAIL IN5URERISIAFF0.RDIhIGCOVERAGE N81C (303) 414-6000 00314693 INSURER A: LCXIIi toll hisuraricCosingainy IA 19437 INSURED Blood Systems, Inc. dba INSURER B: Sentry Insurance a Mutual Com an 24988 1361621 United Blood Services 6210 East Oak / INSURER C : SentryCHSllalt Company all _ t ! 28460 INSURER 0' Scottsdale, AZ 85257 INSURER IN RER F ET Ea aNTurn_„ice XXXXXXX i'n%1PPAnP_Q f":KC}TICI(:A.TC h11IMAl=D• 11677A 1 Fi Y1fYY`Sf yY` 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 IINSR LTR TYPE OF INSURANCE ADDL SIJ9R POLICY NUMBER IPPL€CY EFF MMfDDIYYYY POLICY EXP MM/00lYYYY' LIMITS A COMMERCIAL GENERAL LIABILITY N N 00314693 11/1/2015 11/1/2016 EACH OCCURRENCE XXXXXXX CLAIMS -MADE OCCURPREIdA1 L�J ET Ea aNTurn_„ice XXXXXXX IVIED EXP (Any oneperson) XXXXXXX PERSONAL & ADV INJURY $ XXXXXXX GEN'L AGGREGATE LIMIT APPLIES PER: POLICY[7 JEC LOC GENERAL AGGREGATE $ See Below PRODUCTS - COMP/OP AGG $ XXXXXXX $ OTHER B AUTOMOBILE LIABILITY N N 900410102 1l/1/2015 Il/l/2016 EOMBBCideD+SINGLE LIMIT $ 1.000.000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO AUTOS NED SCHEDULED BODILY INJURY (Per accident $ XXXXXXX NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $XXXXXXX per aCCid@nI $XXXXXXX UMBRELLA LIAB OCCUR EACH OCCURRENCE $ XXXXXXX EXCESS LIAB CLAIMS -MADE NOT APPLICABLE AGGREGATE $XXXXXXX DED —FIRETENTION $ $ C WORKERS COMPENSATIN AND EMPLOYERS' LIABILITY YIN OFFICER/MEMBER EXCLUDED? ECUTIVE - , I (Mandatory in NH) If yes, describe under DESCnIPTION OF OPERATIONS below N / A N 900410101 11/1/2015 I l/I/2016 XsTATUTE OTH- E L EACH ACCIDENT $ 1.000,000 E.L. DISEASE - EA EMPLOYEE 1.000.000 EL DISEASE - POLICY LIMIT 1 1,000,000 A GL/AL/EL (Occ)N Prof. Liab (CM) GL/PL SIR N 00314693 11/1/2015 I l/l/2016 $5,000,000 Aggregate $5,000,000 Aggregate $1,000,000 Each Occurrence/Incident DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *Actual limits may be greater than those shown. Re: Lease requirements for property at SLO City Yard, San Luis Obispo, CA. Parking for United Blood Services blood bank bus. City of San Luis Obispo is Additional Insured as respects General and Auto Liability. L:tKiWIGAIk NVLUIzK I:ANC:ELLATIVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12672616 AUTHORIZED REPRESENTATIVE City of San Luis Obispo Attn: Deputy City Clerk 990 Palm Street San Luis Obispo CA 93401 IC f ACORD 25 (2014/01) ©1 B812014 ACORD CORPO ATION. All riahts reserved Tho ar'()Rrl nama anri Inn^ nra rania+ararl morka of Ar.nprl A.M. Best's Consumer Insurance Information Center Page 1 of I A. M. Best's - camp Member Center: Loa In I Sion Up I Need Coverage? How Does Your Insurer Rate? State Insurance Informatton Find insurers by state or coverage type enb!a n Cnmpnay nrT 1 IMj seled a slate v Consumer Home Terms to Know Why a Best's Rating is Important I Contact Us © Life & Retirement O Health & Disability Car & Home O Other Life Events I Lexington Insurance Company I9 Print thtsgag e (a member orAmerican Intemalianal Group) AM Best# 02350 NAIC#:19437 rENa 2t,.19495¢4 Address: 99 High Street Phone: 617-330-1100 23rd Floor Fax Boston, MA 02110 Web: ww_w.aln e_om_ UNITED STATES Best's Ratings VVI wortwon Need More information? Financial Strength Rating: A u Purchase an insurer report, complete with Implication: Negative CreditRelftfittcompetitive rating history, market share and a list of Effective Date: January 27, 2016 (Under Review) insurers for $ 9:95. View Sample Report Financial Size Category: XV (E2 Billion or greater) u Denotes Under Review Best's Ratings Licensing: The company is licensed in Delaware It also operates on a surplus lines or non -admitted basis in the District of Columbia, Puerto Rico, U S Virgin Islands, AL, AK, AZ, AR, CA, CO, CT, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI and WY It also operates in Great Britain, Puerto Rico, USVI and Bermuda Top Line(s) of Business (based upon Direct Premiums Written) 1 Fire rymw ournnwrt ) 2 Allied Lines (yrmv pprnn an ) 3 Other Liability (Occurrence) mbw uonalun ) 4 Other Liability (Claims-made)iviewoanrwon> 5 Medical Professional Liability (vmw Oerromn ) Top State(s) of Business (based upon Direct Premiums Written) 1 California 2 Florida 3 Texas 4 New York 5 Illinois Visit our News Room for the latest News and Press Roseasos for this company and its A M Best Group Terms of Use All information provided on the A M Best website, including but not limited to text, data, ratings, reports, images, photos, graphics, and charts is owned by or licensed to A M Best Company and is protected by United States copyright laws and international treaty provisions. A M Best and its licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Parties, or stored in a database or retrieval system in any form for commercial purposes without the prior written permission of the A M Best Company All unauthorized use of Best's Credit Ratings or other published information is strictly prohibited By logging into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Use Quglomer Servipe I Prod ! 5 em ir Cen I Oonlact InI garem r AbW A M. Qn. I S+le Mau I Privacy Policy I Security I Twrms of Use I Legal a Ltcenslrin Copyright © 2016 A.M Best Company, Inc and/or its affiliates ALL RIGHTS RESERVED http : //www3 . ambest. com/consumers/CompanyPro file. aspx?BL=3 6&ambnum=0023 5 0&P... 3/24/2016 A.M. Best's Consumer Insurance Information Center Page 1 of 1 A.M. Best'sCUMNOW bb* COPAW 10 Member Center: Loa In I Sion Up Need Coverage? How Does Your Insurer rR�Rate? State Insurance Information Find insurers by state or coverage type Enter a Company Name soma a Sim v Consumer �Ho lme Terms to Know I Why a Best's Rating is Important I Contact Us © Life & Retirement O Health & Disability Q Car & Home ® Other Life Events Sentry Insurance a Mutual Company 8 Pnntthtsaaae (a member of Sentry Insurance Group) AM 80114 02406 NAIC * 24988 FEIN 9: 39-0333950 Address: 1600 North Point Drive Phone: 715-346-6000 Stevens Point, WI 54461 Fax: 715-346-7516 UNITED STATES Web: ax: sentry cnm Best's Ratings v .:; (1 rin:ur.., Need More information? Financial Strength Rating: A+ Pur an insurer report, complete with rating history, market share and a list of Outlook: Stable competitive insurers for $ 9 95 Effective Dale: May 13, 2015 (Affirmed) View narriple Re orl Financial Size Category: XV ($2 Billion or greater) Licensing: The company is licensed in the District of Columbia, Puerto Rico and all states It is also licensed in Canada in the provinces of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec and Saskatchewan Top Line(s) of Business (based upon Direct Premiums written) 1 Workers' Compensation 0kXfUarj5!0wn t 2 Auto (Commercial) tyiew o L,,ffim ) 3 Auto (Personal) tymw oafin8ma / 4 Other Liability (Occurrence)eriawoonmtian> 5 Allied Lines ry=a�rn_+aeon) Top State(s) of Business (based upon Direct Premiums written) 1 Wisconsin 2 California 3 Alabama 4 Colorado 5 Texas Visit our NewsRoom for the latest News and Press Re5pww, for this company and its A M Best Group Terms of Use All information provided on the A M Best website, including but not limited to text, data, ratings, reports, images, photos, graphics, and charts is owned by or licensed to A M Best Company and is protected by United States copyright laws and international treaty provisions A M Best and its licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Parties, or stored in a database or retrieval system in any form for commercial purposes without the prior written permission of the A M Best Company All unauthorized use of Best's Credit Ratings or other published information is strictly prohibited, By logging into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Use Customer service I Product Suoppri I Member Cqnte I QqnIpgt Info I gareasa phPul A M Best I ,y{i g an I PfrveCY Pot cy I Security I Terms o[ Use I Le9a1_8 Licen6ir]a Copyright © 2016 A M Best Company, Inc and/or its affiliates ALL RIGHTS RESERVED http : //www3 . ambest. com/consumers/C ompanyProfile. aspx?B L=3 6& ambnum=002466&P... 3/24/2016 A.M. Best's Consumer Insurance Information Center Page 1 of 1 A.M, Best's ` 60 Member Center: Loa In I Sion U Need Coverage? How Does Your Insurer Rate? State Insurance Information Find insurers by state or coverage type 10"Im a Company Nome I =J Select a Said v Consumer Home I Terms to Know I Why a Best's Rating is Important I Contact Us 0 Life & Retirement O Health & Disability 0 Car & Home © Other Life Events Sentry Casualty Company (a member of Sentry Insurance Group) AM Best #- 03598 NAIL #: 28480 FEIN #: 88-0119248 Address: 1800 North Point Drive Stevens Point, WI 54481 UNITED STATES Best's Ratings vio2winito Financial Strength Rating: A+ Outlook: Stable Effective Date: May 13, 2015 (Affirmed) Financial Size Category: XV ($2 Billion or greater) Licensing: The company is licensed in the District of Columbia and all stales Top Line(s) of Business (based upon Direct Premiums Wrieen) 1 Workers' Compensation (view ignmwa ) 2 Other Liability (Occurrence) (yawr pgortirdn ) 3 Auto (Commercial) t Nfin4lcrr ) 4 Excess Workers' Compensation fv+ow oe(in„(vn ) Top State(s) of Business (based upon Direct Premiums Written) 1 Wisconsin 2 California 3 Illinois 4 Texas 5 New York Phone: 715-346-6000 Fax: 715-346-7516 Web: www sentrv.com Visit our NewsRoom for the latest News and Press Releases for this company and its A.M_ Best Group_ 19 Print INA aaae Need More information? urchase an insurer report, complete with rating history, market share and a list of competitive insurers for $ 9 95 Vlflw am Lila Repan Terms of Use All information provided on the A. M Best website, including but not limited to text, data, ratings, reports, images, photos, graphics, and charts is owned by or licensed to A M Best Company and is protected by United States copyright laws and international treaty provisions A M Best and its licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Parties, or stored in a database or retrieval system in any form for commercial purposes without the prior written permission of the A M, Best Company All unauthorized use of Best's Credit Ratings or other published information is strictly prohibited By logging into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Use CuMpmW-ao I Product Support I Mem har Cvnler I Cont. .pct Ini I Cars Abraut A M �esj I §Ite Me I Privacy Pollcv I Security I Terms of Use I Legal: & Licensing Copyright © 2016 A M Best Company, Inc and/or its affiliates ALL RIGHTS RESERVED http://www3.ambest.com/consumers/CompanyProfile.aspx?BL=36&ambnum=003 588&P... 3/24/2016