ACORD® CERTIFICATE OF PROPERTY INSURANCE DATE (MM/DDYYYY) 03/04/2025
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
PRODUCER CONTACT
NAME:
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE
5 Concourse Parkway PAN Ex: 844-357-0403 FAX, NO):
Suite 2150 REss: [email protected]
ODUC
Atlanta GA, 30328 STOMER.
INSURERS) AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hiscox Insurance Company inc. 10200
Vathanatham Lao Foundation
235 W Main St INSURER B
Merced, CA 95340 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
LOCATION OF PREMISES / DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) 235 W Main St, Merced, CA 95340
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 ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM:
INSR TYPE OF INSURANCE POLICY NUMBER
LTR COVERED PROPERTY LIMITS
PROPERTY BUILDING
CAUSES OF LOSS DEDUCTIBLES PERSONAL PROPERTY $ 10,000
BASIC BUILDING BUSINESS INCOME
$
P103.150.064.2 04/04/2025 04/04/2026
BROAD CONTENTS EXTRA EXPENSE
SPECIAL $ 500 RENTAL VALUE
EARTHQUAKE BLANKET BUILDING
WIND BLANKET PERS PROP
$
FLOOD BLANKET BLDG & PP $
$
INLAND MARINE TYPE OF POLICY
CAUSES OF LOSS
NAMED PERILS POLICY NUMBER
CRIME
TYPE OF POLICY
BOILER & MACHINERY /
EQUIPMENT BREAKDOW Es as es us es en
SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Lao Boat Racing Festival, Merced Yosemite Lake August 24, 2024. The County of Merced, its Board of Supervisors, officers, employees, and agents are included as additional insureds, May 17th 2025.
CERTIFICATE HOLDER CANCELLATION
The County of Merced, its Board of Supervisors, officers, employees, and age nts are included as Al SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 715 MLK Jr Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Merced, CA 95341 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Many Bayed
© 1995-2015 ACORD CORPORATION. All rights reserved.
ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
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).
CONTACT
PRODUCER NAME:
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA PHONE (888) 202-3007 (A/C. No. Ext):
5 Concourse Parkway E-MAIL [email protected]
Suite 2150 ADDRESS:
Atlanta GA, 30328 INSURERS) AFFORDING COVERAGE NAIC#
INSURER A : Hiscox Insurance Company Inc 10200
INSURED INSURER B :
Vathanatham Lao Foundation INSURER C:
235W Main St
INSURER D:
Merced, CA 95340
INSURER E:
INSURER F:
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING 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 LIMITS
LTR TYPE OF INSURANCE INSP WYD. POLICY NUMBER
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS MADE X OCCUR PREMISES (Ea occurrence) $ 0
X CGL is on BOP Form MED EXP (Any one person) $ 10,000
A P103.150.064.2 04/04/2025 04/04/2026 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS - COMP/OP AGG $ 2,000,000
OTHER: 60 44
COMBINED SINGLE LIMI
AUTOMOBILE LIABILITY la acciden
BODILY INJURY (Per person) $
ANY AUTO
AUTOR NED SCHEDULED BODILY INJURY (Per accident) $
AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE
:
EXCESS LIAB CLAIMS-MADE AGGREGATE
DED RETENTIONS
WORKERS COMPENSATION STATUTE
AND EMPLOYERS LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? NIA
(Mandatory in NH) E.L. DISEASE • EA EMPLOYEE $
describe under E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ff more space is required) The Lao Boat Racing Festival, Merced Yosemite Lake August 24, 2024. The County of Merced, its Board of Supervisors, officers, employees, and agents are inc luded as additional insureds, May 17th 2025.
CERTIFICATE HOLDER CANCELLATION
The County of Merced, its Board of Supervisors, officers, employees, and age nts are included as Al SHE EXPIRATION DATE THERE LEERED
NOTICE WILL BE DELIVERED IN
715 MLK Jr Way ACCORDANCE WITH THE POLICY PROVISIONS.
Merced, CA 95341
AUTHORIZED REPRESENTATIVE
Many Bogd
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD