Laserfiche WebLink
A� ®® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDI Y) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 policy(les) 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 certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Bowermaster & Associatesr <br />10805 Holder St <br />Ste 350 <br />NAME: CONTACT Melissa Woods <br />PHONE 714-733-6200 ac No): 714-252-8253 <br />E-MAIL <br />ADOREss: mwoods bowermaster.com <br />Cypress CA 90630 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Philadelphia Indemnity Insurance <br />18058 <br />9/152017 <br />INSURED ILLUFOU-01 <br />Illumination Foundation <br />INSURER B: Philadelphia Insurance Companies <br />CLAIMS -MADE OCCUR <br />2691 Richter Avenue <br />INSURER C: <br />INSURER D: <br />Suite 107 <br />Irvine CA 92606 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 1496317208 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDI <br />POLICY EXP <br />MMIDDYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />V <br />PHPK1712176 <br />9/152017 <br />9115/2018 <br />EACH OCCURRENCE $1,000,000 I <br />CLAIMS -MADE OCCUR <br />DAMAGETORENTED <br />PREMISES RENTrrence $100,000 <br />MED EXP (Any one person) $5,000 <br />PERSONAL &ADV INJURY $1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $3,000,000 <br />GEN'L <br />X <br />POLICY 0 JECT PRO- ❑ LOC <br />PRODUCTS - COMP/OP AGG $3,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE <br />LIABILITY <br />PHPK1712176 <br />9/152017 <br />9/152018 <br />COMBINED SINGLE LIMIT $1,000,000 <br />Ea accident <br />BODILY INJURY (Per person) $ <br />X <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />) BODILY INJURY (Per eccldent $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE $ <br />Per accident <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />PHUB600483 <br />9/1512017 <br />9/152010 <br />EACH OCCURRENCE $1,000,000 <br />AGGREGATE $1,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X RETENTION$ In Q,Q <br />$ <br />WORKERS COMPENSATION <br />PER OTH- <br />AND EMPLOYERS' LIABILITY Y/N <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />ANYPROPRIETOR/PARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? ❑ <br />NIA <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $ <br />A <br />Improper Sexual Conduct <br />PHPK1712176 <br />911512017 <br />9/152018 <br />Per Occurrence 1,000,000 <br />B <br />Commeraal Cyber Liability <br />PHSD1285142 <br />911512017 <br />9/15/2018 <br />Agg:$3,000, 000 /Each 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana, it's officers, employees, agents, and volunteers are Additional Insured with respects to General Liability per attached endorsement form: <br />Primary and Non -Contributory wording applies per attached endorsement form. <br />CERTIFICATE HOLDER CANCELLATION <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />Community Development Agency (M-25) <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />AUTHORI ED REPRESENTATIVE <br />P.O. Box 1988 <br />Santa Ana CA 92702 <br />USA <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />