ACORD® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 INSURERS), AUTHORIZED REPRESENTATIVE 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 on this certificate does not confer rights to the certificate holder in lieu of such endorsements).
Fluetsch and Busby Insurance
Fluetsch and Busby Insurance PHONE
AC. No, Ext): 209-722-1541 (ANG, No): 209-723-8189
PO Box 780 2 MATE
ADDRESS: [email protected]
Merced, CA 95341 INSURERS) AFFORDING COVERAGE
NAIC #
INSURER A : Fireman's Fund Insurance Company 21873
INSURED
INSURER B:
MMSA
INSURER C:
531W Main Street
INSURER D:
Merced, CA 95340
INSURER E :
INSURER F:
COVERAGES REVISION NUMBER:
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.
INSR ADDL SUBR LICY B
LTR TYPE OF INSURANCE POLICY NUMBER M/DD/YYYY (MM/DD/Y LIMITS INSD WVD.
A COMMERCIAL GENERAL LIABILITY
UST022072230 12/2/2023 12/3/2023 | EACH OCCURRENCE 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE PREMISES 50,000
NAEP111423
Host Liquor Liability MEDICAL EXPENSE 1,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO.
LOC PRODUCTS - COMP/OP AGG 1,000,000
OTHER:
A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO BODILY INJURY (Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY (Per accident)
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
UMBRELLA LIAB OCCUR
EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE
AGGREGATE
DED RETENTIONS $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY FATUTE
YIN
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBEREXCLUDED? N/ A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
LYSTOFOPERATIONS below E.L. DISEASE - POLICY LIMIT | $
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional Insured: City of Merced, its officers, agents, employees and volunteers
CERTIFICATE HOLDER CANCELLATION
City of Merced SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
678 West 18th Street
Merced, CA 95340 AUTHORIZED REPRESENTATIVE
Robert V. Nuccio
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Certificate Number: NAEP111423 Policy Number: UST022072230 Effective Dates: 12/2/2023 12:01am to 12/3/2023 12:01am Additional Insured - Person, Organization or other Entity 600002STEP 09 12
Policy Amendments) Commercial General Liability
This endorsement modifies insurance provided under the following:
Commercial General Liability Coverage Part
Schedule
Name of Additional Insured Person(s) or Organization(s) or other Entity(ies) City of Merced
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 include ny Additional Insured Person(s) or Organization( as an insured the person, organization or other entity r other Entity(ies) covered under this policy is subje shown in the Schedule above but only to the extent to the policy forms, terms, conditions, exclusions, limitations and provisions
that bodily injury, property damage or personal and
advertising injury is caused by the sole negligence of the This Endorsement is otherwise subject to all the terms, Memorandum of Insurance holder. conditions, exclusions, limitations, and provisions of the policy to which it is attached.
This Form must be attached to Change Endorsement when issued after the policy is written.
One of the Fireman's Fund Insurance Companies as named in the policy Secretary President
600002STEP9-12
© 2012 Fireman's Fund Insurance Company, Novato, CA. All rights reserved