|
...,� GRAFPRO.01 _ S
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MM)DDJYYYY)
<br />T 02/19/2616
<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 pollcy(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 door not confer ti hts to the certificate holder In lieu of such endorsement (sJ.
<br />PRODUCER License # 0757775
<br />Go1lOatd, CA •HUB international Insurance Servieas Inc. (A//��, No E.tL (925 669 5500 _ {FOC Nq} �25� 609.6550
<br />2300 Clayton Rd. - --'.
<br />Concord, CA 94520 A.r;ss
<br />INSURED
<br />Graffiti Protective Coatings, Inc,
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />R=%AQ1r%M MI 1Mp1Pl .
<br />FCERTIFICATE
<br />O CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FORTHEPOLICY PERIOD
<br />. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />NS AND CONDITIONS OF SUCH POLICIES_ LIMITS S_H_OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS����—���AODL xUeR—'"'""PauvsluMirxTYPO DF INSURANCE ! POLICY NUMaERMMERCIAL tlENERAL DADILnY iIMM
<br />EACH�GQUR ENCE 1'000'800
<br />-1I DAMAGE TO RENTED 100,000
<br />cI.NMs MADE fX OCCUR X jMKLV6ENV100735 (02!1712018 i 0 2/1 712 0 1 0 5,000
<br />-'-- I 1 ( 1,000,000
<br />PER"�,ON„AJ�$�DV
<br />GERL AGOREGA_1'E LIMIT APPLIES PER: I _ I iOENCMLAGGRECATE 1 2'888'888
<br />t p j - 2,000,000
<br />POLICY LXjJ LOU I ,,PRQgUCTxCOMP/OP AOG _$
<br />_
<br />COMBINED SINGLE LIMIT1,088,000
<br />B AUTOMOBILE LIAa7L11Y i At1IXU— �Ls .—
<br />X ANY AUTO 1 X X #52291466837018 101/01120180110112019LBouLY IN JURY(Perpereon,) („S .
<br />ALTOS 3CUTOaULEO BOGIV INJURY JPer acdCentIl __
<br />AV�ggTg�OppS ONLY 1__.ti rypry� OPER}y pAMAOE
<br />AUTOS ONLY L...! RUT 60 Lif%raalCi _ .,_,.,,_i''$" _... _ _m
<br />UMBRELLAtiAe 1 OCCUR 1 jEACH OCGURRENOP„�_„_„$ ,�
<br />EXCESS LIA13 11 CLAIMS-MAOE g E°ATE —I s
<br />i r OED I RETENTIONS p
<br />B iWORKERS COMPENSATION i X UTE FIR a.
<br />IANC EMPLaYERs'uAalun p VVC2Z91466837028 101/01/201810110112019 -=EL EAa a74.ENr <g. 9,00008D
<br />�ANY PROPRIE70Rh'ARTNERfIXECUflVE i )"`i X ! ...
<br />ppFICEWMg MU, EXCLUDED? i Y I NIA I I 1,000888
<br />tMantlet�ry In NN) - LE6 O. E EA EMPLOYEFJ�. _,„�_'
<br />IID RI to BION OnFefP, _ONsb ( j EL DiS5A Pg41CYLiMIT' 1'888'888
<br />A jPollution LlabiUtyMKLV5ENV10C 1735 10211712018 0211712010 JEaah Condition i 1,000,000
<br />I 1 1 I
<br />i
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUPnal Remarks Schedule, MaY Be anached if mere apace Is required)
<br />Re: service Contract.
<br />City of Long Beach, its officials, employees and agents, as additional Insured as respects to General Liability per attached CG 20 37 0704 and additional
<br />Insured In respects to Auto Liability per attached AC 84 07 0713. Waiver of Subrogation applies to Auto Liability per AG 84 07 0713and Workers
<br />Compensation per attached WC 04 D3 06 (ed. 4.84), all as required by written contract
<br />r
<br />ACORD 25 (2016103) wr' TNaa^LO'lO RVVKW wvrcrvruar rvrv. Ra rlBina rvssn,vvc,.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Long Beach
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />FMKNr�{{,tjFrtT/.!'..r,'-'-
<br />Purchasing Agent
<br />333 West Ocean Bivd., 7th Floor
<br />Long Beach„ CA 90802
<br />--
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) wr' TNaa^LO'lO RVVKW wvrcrvruar rvrv. Ra rlBina rvssn,vvc,.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|