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KPCRMEOC 21 (2021 06 28)
EVIDENCE OF COVERAGE ISSUE DATE (MM/DD/YY)
11/12/2024
SPONSOR
Kaiser Foundation Health Plan, Inc.
Attention: Corporate Risk Management
One Kaiser Plaza, 25
th Fl.
Oakland, CA 94612
_________________________________________________________
COVERED ENTITIES
Kaiser Foundation Health Plan, Inc.
Kaiser Foundation Hospitals
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE ARRANGEMENTS SET FORTH BELOW.
_________________________________________________________
COVERAGE AFFORDED
_________________________________________________________
LETTER A
Self-insured
COVERAGES
CO
LTR
TYPE OF COVERAGE DESCRIPTION EFFECTIVE DATE
(MM/DD/YY)
EXPIRATION
DATE (MM/DD/YY)
LIMITS
A Hospital/Physician/Professional
Liability
Self-Insured 1/1/2024 1/1/2025 Each Occurrence: $ 5,000,000 Annual Aggregate: None
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS This certificate provides evidence of professional liability coverage for the above-named entities in accordance with a written contract or agreement.
[RC010094]
CERTIFICATE HOLDER
Nafisah Ali
City of Alameda
2263 Santa Clara Ave., Rm. 130,
Alameda, CA 94501
CANCELLATION
NOT APPLICABLE
_________________________________________________________
AUTHORIZED REPRESENTATIVE
Martin King, VP
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be e ndorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A st atement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO D 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. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2016 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
X
GLALW
5,000,000
S.I.R. $5,000,000
15105
A
01/01/2025 X
CN101483686-NCAL-CAS-24-25
5,000,000
SEA-003740854-15
01/01/2024
X
5,000,000
11/14/2024
6 5,000,000
CA
5,000,000
5,000,000
A
01/01/2025
01/01/2024CA6675880
10,000
SP 4067916
5,000,000
THE CITY, ITS CITY COUNCIL, BOARDS, COMMISSIONS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY TO THE EXTENT REQUIRED BY WRITTEN CONTRACT.
REQUEST #RC010094
KAISER FOUNDATION HOSPITALS
KAISER FOUNDATION HEALTH PLAN, INC.
OAKLAND, CA 94612
ONE KAISER PLAZA, 25B
5,000,000
Safety National Casualty Corp.
X
FOUR EMBARCADERO CENTER, SUITE 1100
MARSH RISK & INSURANCE SERVICES
SAN FRANCISCO, CA 94111
CALIFORNIA LICENSE NO. 0437153
A
GL 4048017
N
ALAMEDA, CA 94501
CITY OF ALAMEDA
2263 SANTA CLARA AVENUE
01/01/2024
$1,000,000 SIR
A
4,000,000
X
01/01/2025