ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?
INSR ADDLSUBRLTR INSDWVD
PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURED INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :
POLICY NUMBERPOLICY EFFPOLICY EXPTYPE OF INSURANCELIMITS(MM/DD/YYYY)(MM/DD/YYYY)
AUTOMOBILE LIABILITY
UMBRELLA LIABEXCESS LIABWORKERS COMPENSATIONAND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
AUTHORIZED REPRESENTATIVE
EACH OCCURRENCE$DAMAGE TO RENTEDCLAIMS-MADEOCCUR $PREMISES (Ea occurrence)MED EXP (Any one person)$PERSONAL & ADV INJURY$GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$PRO-POLICYLOC PRODUCTS - COMP/OP AGGJECT OTHER: $COMBINED SINGLE LIMIT$(Ea accident)ANY AUTO BODILY INJURY (Per person)$OWNEDSCHEDULEDBODILY INJURY (Per accident)$AUTOS ONLYAUTOSHIREDNON-OWNEDPROPERTY DAMAGE$AUTOS ONLYAUTOS ONLY(Per accident)$OCCUR EACH OCCURRENCECLAIMS-MADEAGGREGATE$DEDRETENTION$ PEROTH-STATUTEERE.L. EACH ACCIDENTE.L. DISEASE - EA EMPLOYEE$If yes, describe underE.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGENAIC #
COMMERCIAL GENERAL LIABILITY
Y / NN / A(Mandatory in NH)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE 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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement onthis certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGESCERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDERCANCELLATION
© 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03)
CERTIFICATE OF LIABILITY INSURANCEDATE (MM/DD/YYYY)
$
$$$$
The ACORD name and logo are registered marks of ACORD
11/6/2025
License # 0D44424(661) 316-5126(661) 281-499218058The Open Door Network1921 19th St.Bakersfield, CA 93301 A 1,000,000XXPHPK25735520037/1/20257/1/2026100,0005,0001,000,0003,000,0003,000,0001,000,000A XXPHPK25735520037/1/20257/1/20265,000,000A PHUB8713490037/1/20257/1/20265,000,00010,000B NPUWCG00120251/1/20251/1/20261,000,0001,000,0001,000,000 The City of Bakersfield, its mayor, council, officers, agents, employees and volunteers is an Additional Insured with respect to general liability & auto liability including waiver of subrogation if required or agreed to in a written contract subject to all provisions and limitations of the policy per form PO GLD HS 10 11 & PI CA 001 09 15. General Liability & Auto Liability Coverage is Primary and Non Contributory per policy forms CG 00 01 04 13 & CA 00 01 03 10. Cancellation Notice per policy provisions City of BakersfieldOffice of Risk Management1600 Truxtun Ave.Bakersfield, CA 93301 THEOPEN01CHSCHWARTZLER
INSURICA8500 Stockdale Highway, Suite 200Bakersfield, CA 93311Hilary [email protected] Indemnity Insurance CompanyNonProfits United WC Group X
X XXXXXX
:
CA 00 01 03 10© Insurance Services Office, Inc., 2009Page 9of 12 B. General Conditions1. BankruptcyBankruptcy or insolvency of the "insured" or the "insured's" estate will not relieve us of any obli-gations under this coverage form. 2. Concealment, Misrepresentation Or FraudThis coverage form is void in any case of fraud by you at any time as it relates to this coverage form. It is also void if you or any other "in-sured", at any time, intentionally conceal or misrepresent a material fact concerning: a.This coverage form; b.The covered "auto"; c.Your interest in the covered "auto"; or d.A claim under this coverage form. 3. LiberalizationIf we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the addi-tional coverage as of the day the revision is ef-fective in your state. 4. No Benefit To Bailee – Physical Damage CoveragesWe will not recognize any assignment or grant any coverage for the benefit of any person or organization holding, storing or transporting property for a fee regardless of any other pro-vision of this coverage form. 5. Other Insurancea.For any covered "auto" you own, this cov-erage form provides primary insurance. For any covered "auto" you don't own, the in-surance provided by this coverage form is excess over any other collectible insurance. However, while a covered "auto" which is a "trailer" is connected to another vehicle, the Liability Coverage this coverage form pro-vides for the "trailer" is: (1)Excess while it is connected to a motor vehicle you do not own. (2)Primary while it is connected to a cov-ered "auto" you own. b.For Hired Auto Physical Damage Coverage, any covered "auto" you lease, hire, rent or borrow is deemed to be a covered "auto" you own. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto".c.Regardless of the provisions of Paragraph a.above, this coverage form's Liability Coverage is primary for any liability as-sumed under an "insured contract". d.When this coverage form and any other coverage form or policy covers on the same basis, either excess or primary, we will pay only our share. Our share is the proportion that the Limit of Insurance of our coverage form bears to the total of the limits of all the coverage forms and policies covering on the same basis. 6. Premium Audita.The estimated premium for this coverage form is based on the exposures you told us you would have when this policy began. We will compute the final premium due when we determine your actual exposures. The estimated total premium will be credited against the final premium due and the first Named Insured will be billed for the bal-ance, if any. The due date for the final pre-mium or retrospective premium is the date shown as the due date on the bill. If the es-timated total premium exceeds the final premium due, the first Named Insured will get a refund. b.If this policy is issued for more than one year, the premium for this coverage form will be computed annually based on our rates or premiums in effect at the beginning of each year of the policy. 7. Policy Period, Coverage TerritoryUnder this coverage form, we cover "accidents" and "losses" occurring: a.During the policy period shown in the Dec-larations; and b.Within the coverage territory. The coverage territory is: (1)The United States of America; (2)The territories and possessions of the Unit-ed States of America; (3)Puerto Rico; (4)Canada; and(5)Anywhere in the world if: (a) A covered "auto" of the private passen-ger type is leased, hired, rented or bor-rowed without a driver for a period of 30 days or less; and (b) The "insured's" responsibility to pay damages is determined in a "suit" on the merits, in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to.