Page 23 - Statement Of Qualifications Flipbook 080718

09/29/2017
LIC #0056172
1-888-845-2248
McSherry & Hudson
408-550-2130
160 West Santa Clara Street
Suite 715
San Jose, CA 95113
19489
Charles M. Griswold
ALLIED WORLD ASSUR CO US INC
ZURICH AMER INS CO
16535
Ferma Corporation
STARR IND & LIAB CO
38318
INDIAN HARBOR INS CO
36940
1265 Montecito Avenue, Suite 200
Mountain View, CA 94043-4506
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 408-550-2119
09/29/2017
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 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 LIC #0056172 1-888-845-2248 CONTACT
McSherry & Hudson NAME: FAX
PHONE
(A/C, No, Ext): 408-550-2130 (A/C, No): 408-550-2119
E-MAIL
160 West Santa Clara Street ADDRESS:
Suite 715
San Jose, CA 95113 INSURER(S) AFFORDING COVERAGE NAIC #
Charles M. Griswold INSURER A : ALLIED WORLD ASSUR CO US INC 19489
INSURED INSURER B : ZURICH AMER INS CO 16535
Ferma Corporation
INSURER C : STARR IND & LIAB CO 38318
1265 Montecito Avenue, Suite 200 INSURER D : INDIAN HARBOR INS CO 36940
INSURER E :
Mountain View, CA 94043-4506
INSURER F :
COVERAGES CERTIFICATE NUMBER: 51024833 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 POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS
A GENERAL LIABILITY 0310-3515 10/01/17 10/01/18 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000
PREMISES (Ea occurrence)
X
CLAIMS-MADE OCCUR MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X PRO- $
POLICY JECT LOC
B AUTOMOBILE LIABILITY BAP5833446-05 10/01/17 10/01/18 COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS (Per accident) $
$
C UMBRELLA LIAB X OCCUR 1000584640171 10/01/17 10/01/18 EACH OCCURRENCE $ 15,000,000
X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 15,000,000
DED RETENTION $ $
B WORKERS COMPENSATION WC 5833447-05 10/01/17 10/01/18 X WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? Y N / A
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
D Pollution Liability PEC004465703 10/01/17 10/01/18 Per Claim/Agg 5,000,000
D Professional Liability PEC004465703 10/01/17 10/01/18 Each/Aggregate 5,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
RE: Proof of Insurance.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1265 Montecito Avenue, Suite 200 AUTHORIZED REPRESENTATIVE
Mountain View, CA 94043
USA
© 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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51024833