HomeMy WebLinkAboutHousing AuthorityCERTIFICATE OF COVERAGE
ImA; DATE(MMODUTY)
1 09/01/16
PRODUCER
THIS CERTIFICA'fl:1S ISSUED ASA MAT'I'E3R OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES
NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
HOUSING AUTHORITIES RISK RETENTION POOL
BELOW.
7111 NE 179" STREET
VANCOUVER, WASHINGTON 98686
CDCOMPANIES
AFFORDING COVERAGE
(360)574-9035
(360) 574-9401 FAX 2D16
7rO
COMPANY HARRP
Housing Authorities Risk Retention POOL
COVERED ENTITY SLO QCITy CLERK
HOUSING AUTHORITY OF THE CITY OF LUIS OBISPO
LETTER A -jC
487 LEFF STREET
P. O. BOX 1289
COMPANY
SAN LUIS OBISPO, CA 93401-1289
LETTER B
PH: 805-543-4478
COVERAGES
THIS IS TOCr-RTFFY i31AT THE POLICIES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED ENTITY NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTwITilsTANI)ING ANY
REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTS WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN- THE INSURANCE AFFORDED BY
THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIFTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
ALL LIMITS
LTR
DATE (MM/DD/YY)
DATE (MM/DD/YY)
A
GENERAL LIABILITY
GENERAL AGGREGATE $2,000000
EACH OCCURRENCE $2,000,000
X COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (any one fire) $2,000,000
CLAIMS MADE X OCCURRENCE
086-PLEAF
10/01/16
10/01/17
OWNERS'S & CONRACTOR'S PROT.
MEDICAL EXPENSES EXCLUDED
AUTOMOBILE LIABILITY
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS
AS RESPECTS: HOMELESS SHELTER at 750 ORCUTT ROAD, SAN LUIS OBISPO, CALIFORNIA, Per the interest of the
CERTIFICATE HOLDER / ADDITIONAL COVERED PARTY, As shown below:
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OF LIABILITY OF ANY KIND UPON
THE COMPANY, ITS AGENTS OR REPRESENTATIVES,
CITY OF SAN LUIS OBISPO
ATTN: CITY CLERK'S OFFICE
AUTHORIZED REPRESENTATIVE
990 PALM STREET
SAN LUIS OBISPO, CA 93401
WILLIAM E. GREGORY, EXECUTIVE DIRECTOR
ENDORSEMENT
HOUSING AUTHORITY OF T14E CITY OF SAN LUIS OBISPO
487 LEFF STREET
P. O. BOX 1289
SAN LUIS OBISPO, CALIFORNIA 93401-1289
MEMBER NO.: 086-PLEAF
COVERAGE PERIOD: 10/01/16 - 10/01/17
AS RESPECTS:
HOMELESS SHELTER
750 ORCUTT ROAD
SAN LUIS OBISPO, CALIFORNIA
LIABILITY: IT IS HEREBY AGREED THAT THE FOLLOWING IS INCLUDED
AS ADDITIONAL COVERED PARTY(IES) AS RESPECTS THEIR
INTEREST IN THE PROPERTY(IES) NAMED ABOVE:
CITY OF SAN LUIS OBISPO
990 PALM STREET
SAN LUIS OBISPO, CALIFORNIA 93401
ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED
09/01/16
DATE WILLIAM E. GREGORY, EXECUTIVE DIRECTOR
HOUSING AUTHORITIES RISK RETENTION POOL
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