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CERTIFICATE OF LIABILITY INSURANCE
E (MM/DD/YYYY) DAT
03/20/14 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 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 619-293-3800
Alcott Insurance Agency, Inc.
3945 Idaho Street 619-293-3896 Sari Diego, CA 92104-2902 James L. DeVito CONTACT NAME: FAX (
Pkirr7o , Eel) : (A/C, No): E-MAIL
ADDRESS: PRODUCER
SDCBC-1 CUSTOMER ID //:
INSURER(S) AFFORDING COVERAGE INSURER A : Philadelphia Insurance Comparyl
NAIC if _ INSURED San Diego County Bicycle
Coalition P.O. Box 34544 San Diego, CA 92163 INSURER B : INSURER C : INSURER D: INSURER B: INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION N
THIS IS TO CERTIFY THAT INDICATED, NOTWITHSTANDING CERTIFICATE MAY BE ISSUED EXCLUSIONS AND CONDITIONS
THE POLICIES OR MAY OF SUCH ANY REQUIREMENT, PERTAIN, POLICIES. ADDL j i OF INSURANCE SUER VVVQ_
LISTED BELOW HAVE BEEN TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY
LIMITS SHOWN MAY HAVE BEEN REDUCED
POLICY NUMBER ISSUED TO CONTRACT THE POLICIES BY POLICY EFF AMM/DD/YYYYL THE INSURED OR OTHER DESCRIBED PAID CLAIMS. POLICY EXP (MM/DD/YYYYI
NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS INSR LTR TYPE OF INSURANCE A X GENERAL LIABILITY COMMERCIAL GENERAL X LIABILITY OCCUR PHPK1030389 07/01/13 07/01/14 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED
PREMISES (Ea occurrence) $ 100,000
CLAIMS-MADE MED EXP (Any one person) 6,000
PERSONAL & ADV INJURY 1,000,000
GENERAL AGGREGATE $ 3,000,000 GENT. AGGREGATE LIMIT APPLIES PER:
—1 POLICY PRO- JECT LOC
PRODUCTS - COMP/OP AGO $ 3,000,000
• X _
X
AUTOMOBILE LIABILITY • ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOSHIRED AUTOS NON-OWNED AUTOS
PHPK1030389 07/01/13 07/01/14
COMBINED SINGLE LIMIT
(Ea eccideni) $ 1,000,000
BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH)
If yes, describe under DESCRIPTION OF OPERATIONS
Y / N N/A
WC STATU- 0TH- TORY LIMITS ER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE $
below El DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of San Diego, its respective elected officials, officers, employees,
agents and representatives are named as additional insured per form CG2026 0704.
Event: CicloSDias on March 30, 2014 **Revises certificate issued 03/14/14**
CERTIFICATE HOLDER
CITYOFS City of San Diego
Purchasing & Contracting Department
1200 Third Avenue, Ste 200 San Diego, CA 92101-4195 1
CANCELLATION
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
frow
POLICY NUMBER: PHPK1030389
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
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)
City of San Diego, its respective elected officials, officers, employees,
agents and representatives
Information
required to complete this
Schedule, if not shown above, will be shown In the Declarations,
Section II — Who Is An Insured is amended to
in-clude as an additional insured the person(s) or
or-ganization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property
dam-age" or "personal and advertising injury" caused, in
whole or In part, by your acts or omissions or the acts
or omissions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you.
DECLARATION OF CONTRACTOR RE: AUTOMOBILE INSURANCE COVERAGE
Regarding the FY 2014 Agreement [Agreement] between the City of San Diego, a
municipal corporation [City] and 5 c,„
1/4-1
C\4;o
[Contractor],
Contractor declares as follows:
1. Contractor does not currently own any vehicles;
2. Contractor has obtained, and. shall maintain during the term of the Agreement,
automobile insurance coverage for "hired autos" and "non-owned autos"; and
3. In the event Contractor subsequently acquires any vehicle(s) during the term of the
Agreement, the Contractor shall immediately obtain, and provide to the City the required
evidence of; automobile insurance coverage for "any auto," as required in Section 12.4 of the
Agreem ent.
For the purpose of this Declaration, automobile insurance coverage for "any auto," "hired
autos," and "non-owned autos" are defined as follows:
Any Auto: Coverage is provided for any auto, including autos owned by the insured, autos the
named insured hires or borrows from others, and other non-owned autos used in the insured's
business.
Hired Autos: Coverage is provided only for autos leased, hired, rented, or borrowed for use in
the named insured's business.
Non-owned Autos: Coverage is provided only for autos not owned, leased, hired, or borrowed
by the named insured. Coverage includes autos owned by the insured's employees or members of
their households, but only while used in the named insured's business or personal affairs.
Authorized Signer Name:
ave? s
Board Position:
Signature:
President and CEP
CERTHOLDER COPY
STATE
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
COMPENSATIONINSURANCE
FUND
ISSUE DATE: 02-13-2014 GROUP;
POLICY NUMBER: 1803409-2014 CERTIFICATE 'ID; 5
CERTIFICATE EXPIRES: 01-01-2015
01-01-2014/01-01-2015
CITY OF SAN DIEGO SD
202 C ST
SAN DIEGO CA 92101-4806
This Is to certify that we have issued a valid Workers' Compensation Insurance policy in a form apprdved by the California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
SD
Authorized Representative
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2066 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
SAN DIEGO COUNTY BICYCLE COALITION SD
PO BOX 34544 SAN DIEGO CA 92163
[PJP,CS]
Authorized Representative
lhowta, F
President and CEOPOLICYHOLDER COPY
SD
STATE
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
COMPENSATIONINSURANCE
FUND
ISSUE DATE: 02-13-2014 GROUP:
POLICY NUMBER: 1803409-2014 CERTIFICATE ID:
CERTIFICATE EXPIRES: 01-01-2015
01-01-2014/01-01-2015
CITY OF SAN DIEGO SD
202 C ST
SAN DIEGO CA 92101-4806
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form apprOved by the California Insurance Commissioner to the employer named below for the policy period indicated,
This policy Is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2012 IS ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
SAN DIEGO COUNTY BICYCLE COALITION SD PO BOX 34544
SAN DIEGO CA 92163
[PJP,CS]
