Loading...
2020/04/27 DocuSign, Inc. Certificate of Liability Insurance DocuSign Envelope ID:791BAC8F-228D-4AC4-BE2B-F3lD159F2661 DATE(MM/DD/YYYY) ,a�oRo® CERTIFICATE OF LIABILITY INSURANCE 4/27/2020 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 w/ p y, 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 CONTACT '6 NAME: AOn Risk insurance Services West, Inc. PHONE FAX San Francisco CA Office (A C.No.Ezt): (866) 283-7122 (A/c.No.): (800) 363-0105 'a 425 Market Street E-MAIL 2 Suite 2800 ADDRESS: San Francisco CA 94105 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Berkley National Insurance company 38911 DocuSign, Inc. INSURER B: StarNet Insurance Company 40045 221 Main Street, Suite 1000 INSURER Lloyd's syndicate No. 3624 AA1120098 Suite San Francisco CA 941051925 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570080361888 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested INSR ADDL SUBR EFF EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (POLICYMM/DD/YYYY) (POLICYMM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY TCP 7007957 14 04/27/2020 04/27/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 P'ILAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $3,000,000 ro POLICY ❑PE LOC PRODUCTS-COMP/OP AGG $3,OOO,OOO o W CT OTHER: 0 r B AUTOMOBILE LIABILITY TCP 7007957 14 04/27/2020 04/27/2021 COMBINED SINGLE LIMIT 'O (Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) O OWNED SCHEDULED BODILY INJURY(Per accident) Z AUTOS d1 AUTOS ONLY PROPERTY DAMAGE iC X HIREDAUTOS X NON-OWNED (Per accident) U ONLY AUTOS ONLY t 01 A X UMBRELLA LIAB OCCUR TUL 7007956 14 04/27/2020 04/27/2021 EACH OCCURRENCE $5,000,000 U X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED I RETENTION A WORKERSCOMPENSATIONAND TWC 7007955 16 04/27/2020 04/27/2021 X I PERSTATUTE OTTH- EMPLOYERS'LIABILITY Y/N JER ANY PROPRIETOR/PARTNER/ ❑ N/A E.L.EACH ACCIDENT $1,000,000 EXECUTIVE OFFICER/MEMBER (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 Dye s,describe under $1,000,000 DESCRIPTION OPERATIONS below E.L.DISEASE-POLICY LIMIT C E&O-PL-Primary MPL216765620 04/27/2020 04/27/2021 Professional Liab $5,000,000 Claims-Made SIR $250,000 =_=_ SIR applies per policy terms & condi ions ■■ .AL. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ` Evidence of Insurance. Professional Liability includes Network Security, Privacy Protection and Cyber Liability. =521 sJ �J~ =16J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION r� DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. J DocuSign, Inc. AUTHORIZED REPRESENTATIVE M= 221 Main Street, Suite 1000J San Francisco CA 9410 5-192 5 USA l n(^X/q ✓GQOJfGc!7IdLGtQ. Y. �GtiuxCd l'yCd/�c!9sC. .� ©1988-2015 ACORD CORPORATION.All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD