|
® Policy Number: CP4957-070-a Date Entered: 07/02/2018
<br />`� G'CERTIFICATE OF LIABILITY INSURANCE DATE{MM/DDIYri^()
<br />//L/—, tt
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION- ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER- THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(IGS) must have ADDITIONAL INSURED provisions or be endorsed,
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this certificate does not confer rights to the ceitificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />interstate Trans Insurance Broker Inc.
<br />CONEACT rV. SK #0G22050
<br />AaM
<br />PRONE (323) 728 0003 Np , (323) 888-2331
<br />P. O. BOIL 911094
<br />Commerce, Ca 90091
<br />7bmoARIbs4l_a.tib2OOO@aol.com Lia# OG22050
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />07/02/2019
<br />EACH OCCURRENCE
<br />d7+MAi r FzENS`e15`
<br />E Eaocnurre
<br />INSURERA3A'J'.A.T.N SPECIALTY INSURANCE C0:4E'AN'X
<br />17159
<br />INSURED INTERITA.TIONAL BUS LINES INC.
<br />NC
<br />INSURER B:MOG"ASSSVE I NUIIAE GOLdPANxES
<br />10243
<br />EVANSTON :WSVE+ANCB C6iiWANY
<br />IN„_SURERC:
<br />37352
<br />INSURE D3 Gid iJR,A1 G QdP
<br />40460
<br />2088 WEST HILLCPM8T DR. B208
<br />NEWBURY PARK, CA 91320
<br />PERSONAL&ADVINJURY
<br />$
<br />INsuRERE:
<br />INSURER F 3
<br />4 V V C[[Hli CJ
<br />ctrc l iPK;A1 k� N
<br />REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />A
<br />S
<br />POLICYNOMSER
<br />POlDt7
<br />POLI DY YYYI EXP
<br />LIMITS
<br />A
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />�/
<br />X
<br />C IP364071
<br />07/02/201$
<br />07/02/2019
<br />EACH OCCURRENCE
<br />d7+MAi r FzENS`e15`
<br />E Eaocnurre
<br />$2,000,000.00
<br />$ 500,000.00
<br />MED EXP An ane rsnn
<br />$ 5, DOD . 00
<br />PERSONAL&ADVINJURY
<br />$
<br />GEN'LAGGREGATE LIMIT APPLIES PER!
<br />POLICY ❑ JRCQT LOC
<br />GENERAL AGGREGATE
<br />$3,000,000.00
<br />PRQDUGTS-CpMpIOPAGG
<br />$
<br />$
<br />OTHER:
<br />S
<br />AUTOMOBILE
<br />LIABILITYM
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />X
<br />C:P4957-070--8
<br />06/22/2018
<br />06/22/2019
<br />1 NGLE U.,I
<br />aaccd0 t
<br />$5 000
<br />, 400^
<br />BODILYFNJURY(Perpersnn)
<br />^—__.0(T'
<br />S
<br />BODILY INJURY (Poraactdant)
<br />S
<br />PR PERTY DAMAO
<br />ancidont) _
<br />$
<br />C
<br />UM9RELLA UAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$3,000,000.00
<br />EXCESS LIAB
<br />CLAIMS•MADr
<br />XOBW7268517
<br />EXCESS GENERAL LTAB
<br />07/02/2018
<br />07/02/2019
<br />AGGREGATE
<br />$ —
<br />DED I I RETENTION $
<br />EXMSS FIRE LGI,
<br />$ ,500, 000.00
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABIUTY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIV6
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />DEclo
<br />SCRIPTION OP OPERATIONS below
<br />NIA
<br />5C -2306159-0:L
<br />06/19/2018
<br />07/02/2018
<br />06/19/241.8
<br />a7/02/2019
<br />PER, 47H-
<br />E„L. EACH ACCIDENT
<br />$ 1, 000 r 000. QO
<br />EL.DISEASE-EAEMPLOYEE
<br />$1,000,000.00
<br />E,L, DISEASE'- POLICY LIMIT
<br />ANNUAL 1,1141T
<br />v$ 1, 000 , 000.00
<br />$ 50,000.00
<br />A
<br />BUSINESS INTERRUPTION
<br />INSURANCE (1 'YEAR. )
<br />CIP36407:L
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Addlttanal Remarks.Schedulo, may be attached If mare space Is roqulred)
<br />Commercial Livery Packaged Policy.
<br />*** Certificate holder is named as additional insured ***
<br />New Location: SANTAANA, CA. 92701
<br />- REVIEWEDBY: EUNICE HERED(A P m�OF
<br />CITY OF SANTA ANA, PUBLIC WORKS AGENCY
<br />SANTA ANA REGIONAL TRANSPORTATION CENTER
<br />1000 E. SANTA ANA.BLVD.SUITE las
<br />SANTA ANA, CA 92701
<br />FAX -714-565-2692
<br />AUORD 26 (2016103)
<br />SHOULD ANY OF THE ABOV5 DESCRIBED POLICIES BE CANCELLED BIEFORE
<br />THE EXPIRATION DATE: THEREOF, NOTICE WILL 13E DELIVIERED IN
<br />ACCORDANCE,WITH THE POLICY MOVISIONS.
<br />AUTHORIZED R R SENTATIVE
<br />Q 1888-2016
<br />Che ACORD name and logo are registered marks ofACORD
<br />Produced using Farms Bass Plus software. www.FormsBoss.com: Impressive PubllshlnD 1300-200-1977
<br />All rights reservgrl
<br />
|