COMPLIANCE INFO_2024 - Laserfiche WebLink

Home Browse Search

I 0 ACCPRE, 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 INSURER(S), 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 endorsement(s). PRODUCER Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150 Atlanta GA, 30328 CONTACT NAME: PHONE FAX mic No Exo: (888) 202-3007 (A/C, No): E-MAIL ADDRESS: contact@hiscox.com INSURER(S) AFFORDING COVERAGE NAIC a INSURER A: Hiscox Insurance Company Inc 10200 INSURED Planet GrubClub 2000, LLC DBA Superchickenman 2044 S. Tuxedo Ave Stockton, CA 95204 INSURER D : INSURER B : INSURER C : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POUCY EFF (M0A/DD/YYTY) POUCY EXP IMWDD/YYYY) UMITS A X COMMERCIAL GENERAL UABIUTY OCCUR Y P102.252.663.1 02/28/2024 02/28/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (My one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT o- APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X RI p policy 1 JECT OTHER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON-OWNED AUTOS COMBINED SINGLE UMIT (Ea accident) $ BODILY INJURY (Per person) $ _____ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE (Per accident) $ — $ _ UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y / N N/A PER 0TH- STATUTE ER E.L EACH ACCIDENT $ EL DISEASE - EA EMPLOYEE $ below EL. DISEASE - POLICY LIMIT $ , , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Stockton, its officers, officials, employees, and volunteers. The Certificate Holder shall be an Additional Insured, but only with respect to the operations of the Named Insured CERTIFICATE HOLDER CANCELLATION City of Stockton 400 E Main Street, 3rd Floor HR Stockton, CA 95202 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD