AUTHORIZED REPRESENTATIVE
201 c 6, Centre for Study of Insurance Operations. All rights reserved.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder and imposes no liability on the insurer.
CERTIFICATE OF LIABILITY INSURANCE
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
POSTAL
CODE
BROKER CLIENT ID:
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 requirements, terms or conditions 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 terms, exclusions and conditions of such policies. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSURANCE COMPANY
AND POLICY NUMBER
EFFECTIVE
DATE
EXPIRY
DATE
LIMITS OF LIABILITY
(Canadian dollars unless indicated otherwise)
NON-OWNED AUTOMOBILES
HIRED AUTOMOBILES
AUTOMOBILE LIABILITY
DESCRIBED AUTOMOBILES
ALL OWNED AUTOMOBILES
** ALL AUTOMOBILES LEASED IN EXCESS OF
30 DAYS WHERE THE INSURED IS REQUIRED
TO PROVIDE INSURANCE
EXCESS LIABILITY
UMBRELLA FORM
OTHER LIABILITY (SPECIFY)
BODILY INJURY AND PROPERTY
DAMAGE COMBINED
BODILY INJURY (PER PERSON)
BODILY INJURY (PER ACCIDENT)
PROPERTY DAMAGE
Should any of the above described policies be cancelled before the expiration date thereof, the issuing company will endeavor to mail ________ days written notice to the certificate holder named above, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.
AUTHORIZED REPRESENTATIVE
ISSUER
DATE
EACH OCCURRENCE
AGGREGATE
This certificate does not amend, extend or alter the coverage afforded by the policies below.
NON-OWNED AUTOMOBILES
POSTAL
CODE
POSTAL
CODE
1. CERTIFICATE HOLDER - NAME AND MAILING ADDRESS INSURED’S FULL NAME AND MAILING ADDRESS DESCRIPTION OF OPERATIONS/LOCATIONS/AUTOMOBILES/SPECIAL ITEMS TO WHICH THIS CERTIFICATE APPLIES (but only with respect to the operations of the Named Insured)
COVERAGES
CANCELLATION
6. BROKERAGE/AGENCY FULL NAME AND MAILING ADDRESS
ADDITIONAL INSURED NAME AND MAILING ADDRESS
(Commercial General Liability- but only with respect to the operations of the Named Insured)
8. CERTIFICATE AUTHORIZATION
COMMERCIAL GENERAL LIABILITY
- GENERAL AGGREGATE
MEDICAL PAYMENTS
TENANTS LEGAL LIABILITY
PRODUCTS AND COMPLETED OPERATIONS
AGGREGATE
- EACH OCCURRENCE
DED. AMOUNT OF
INSURANCE COVERAGE
BODILY INJURY AND PROPERTY DAMAGE
LIABILITY
YYYY/MM/DD YYYY/MM/DD
POSTAL
CODE
PERSONAL INJURY LIABILITY
PERSONAL AND ADVERTISING INJURY
LIABILITY
OR
POLLUTION LIABILITY EXTENSION
7. CONTACT NUMBER(S)
TYPE
TYPE
NO.
NO.
TYPE
TYPE
NO.
NO.
EMAIL ADDRESS SIGNATURE OF
CSIO - Certificate of Liability Insurance CA4301e 201609
HIRED AUTOMOBILES
CLAIMS MADE OR OCCURRENCE
PRODUCTS AND / OR COMPLETED OPERATIONS
EMPLOYER’S LIABILITY
CROSS LIABILITY
WAIVER OF SUBROGATION
2. 3.
4. 5.
LEASED AUTOMOBILES **
TENANTS LEGAL LIABILITY
POLLUTION LIABILITY EXTENSION
City of Redondo Beach MacKay Meters Inc. Purchasing P.O. Box 338 415 Diamond Street Redondo Beach CA 90277 New Glasgow NS B2H 5E3 Confirmation of Insurance - Single and Dual Space Parking Meters The City, its officers, elected and appointed officials, employees, and volunteers shall be covered as insureds with respect to liability arising out of work performed by or on behalf of the Contractor.
The certificate holder is added as an additional insured to the Commercial General Liability Coverage Policy, but only with respect to liability arising out of operations carried out by or on behalf of the Named Insured, excluding any automobile liability. 5,000,000 X 1,000,000 1,000,000 X
1,000,000 10,000 X 1,000,000
Chubb Insurance Company of Canada
35814085
2024/06/30 2025/06/30 X
Chubb Insurance Company of Canada
35814085
2024/06/30 2025/06/30 1,000,000 X
Chubb Insurance Company of Canada
(23)79841661
2024/06/30 2025/06/30 4,000,000 4,000,000 30 Arthur J. Gallagher Canada Limited City of Redondo Beach 227 Main Street Purchasing Antigonish NS B2G 2M5 415 Diamond Street Redondo Beach CA 90277 Arthur J. Gallagher Canada Limited Phone 902-863-3210 Peter Fraser, BBA, CAIB Fax 902-863-1336 2024/07/04 [email protected]