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Last modified
6/9/2022 12:51:07 PM
Creation date
5/22/2019 1:07:17 PM
Metadata
Fields
Template:
Contracts
Company Name
PLACEWORKS, INC.
Contract #
A-2019-064
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Council Approval Date
5/7/2019
Expiration Date
11/5/2020
Destruction Year
2025
Notes
A-2018-077; A-2018-283;
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CERTIFICATE OF LIABILITY INSURANCE ( DATEIMLIIOPIYYYYI <br />ON2812018 <br />IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />1 NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />tTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />)R PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the ca rtlficate 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 endorsements . <br />OOUCER <br />Mash Risk 6 lnsurawa Services .NAMR;_._._...�____. <br />Ann:NowpoABeaChCedRBGUael@maleh.CW; 212-948.4323 ___.—_.,,_iNSURER1al AFFORDING COVERAGE NAICa <br />CN11515692101_01-18.19 ,-- --- <br />wquneRA Cmm&Forsler9paCWlty Insurance Co _ _�.44520 _ <br />INSURED INSURRRB:TMVBNISPmpe CasUally Com an Of America i25674 <br />RaceWark6, Inc _ L� �._ <br />Dba: The Planning Center �_7 . INSURER C +— <br />Design Community s Envmmmant P... ,� �. _ <br />ixsuaEe a: <br />3 MarArBur Race, Suite 10 ... _. - <br />SantaAoa�CA 02707 INSURER <br />INSURER <br />COVERAGES CERTIFICATE NUMBER, LORA022IM46-19 RPVI.glnN NI.IMRFR• 9 <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 <br />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 />7YPROfINSURANCE OLICYNUMe R <br />DUEY1110-71H000Y@XP_I.__......___�_.��..._..�...._- <br />LNITS <br />A X I COMMEROIALOENERALOABILITY X X :EPKI22995 <br />'10701@018 �0710112019 I EACH CCCURRENCS S <br />5000..,.0_00 <br />---I <br />' <br />`DwOETORSTEOCW <br />OCCUR <br />_ <br />%000_ <br />X:; BIaPD Ikd. $5,000 <br />MEDEXPylnone�ersonl s <br />5,000 <br />_. <br />t_.._. . —_ <br />PER50NALAAWINJURY Y <br />._... <br />50001000 <br />GfiN'LAGGREOATE LIMIT APPLIES PER: <br />GENeRALAGGREGATE S <br />5,00,000 <br />_ rR�'i �LOC <br />_X POLICY' : d <br />PRODUCTS-COMPWP AGO _S <br />S,000,W0 <br />OT R: <br />1, Contra M, Pollution S - <br />- 5,000.140 <br />B AUTOMOBILE <br />LIABILITY X X RAK3761671 CAG <br />07/01/2016 0710112019 IN. meeawNll L MI S <br />11000,000 <br />X] <br />ANYAUTO <br />! BODILY INJURY (Pa Param) S-- <br />ppyWyNNED `_�SSCUT�LED <br />AUTOS ONLY <br />,. BODILY INJURY (Peraceldentl9 <br />—_— <br />.__., <br />NON -OWNED <br />"'PflOPERfY OAMFGE 's -- <br />- — <br />...fHIRED <br />AUTOSONLY ,_AUTOSONLY <br />(PAR""TYl_^ <br />Dedudibles S <br />51,000 <br />UMBRRLLALMB XOCCUR-EnJ3287561843 <br />071011M1S 107101019 PACN OCCURRENCE...... .S <br />4.W0,000 <br />X EXCESS LIAR CUIM&MADE <br />AGGREGATE Is <br />4.000000 <br />CEO RETENTION S <br />S <br />-WORKERSOOMPENSATWN UB7K728676VH3Ga <br />R TH- <br />0.TUTE <br />ANDRMPLOYRRS'UABILnY y N <br />ANYPROPRIETORIPARTNERIfiXECUTME <br />,_� <br />1,000,000 <br />OFFICERMEMBEREXCLUDED? N NIA, <br />E.t EACH ACCIDENT s <br />_ <br />(MaldNerykNX) <br />�itysa <br />I E.L. DISEASE_ EA EMPLOYEES <br />1,Wo'lim <br />dxcNbeander <br />-0ESd I N. F ATrON5 O41mY <br />IE.LD26A -POUCY MIT'S <br />1.000,COU <br />A Emas It Omissions -Claim Made--.EPKI22995 <br />071 IX18 0701019 Each CMimlAgglegats <br />5XD0D0 <br />Ratio DART Bee 2nd Page <br />DESCRIPTION OF OPEUIMSI LOCAnONS /VEHICLES (ACORO 141, addlUenal Ramada aekeeWy Maybe aRaahodamem apace kMWwI <br />Ran OpwaBane pelArtmd by OM awed insured for themff4ate holder <br />CRY of Santa Am, IN of sba. allenfs, empoyees, and wkmNem are Included as Mdi6ame sermadwhaerequkad by wNMn malractmlh respect to General and Auto Uabulgr.this Rsurameisprimary <br />andnoa- <br />CW"UIMry cry exisgrg ksuraaceand Brund m llebEty arisllg COOT the opwadons oftenanwdInsured and where Ryi by new ouramw4h Ns General Lianitty. WaNeralwblogaonb <br />aPPIL" where equiNd bywatas coaraCtwlU resPedto Genera and Auto Wdlity. <br />d. �a ' <br />cnrrns.n Fnv vcrt awftNbCLLF IfVN <br />CPYofSaMa Ana SHOULD ANY ABOVEDESORIBED POLICIES BE CANCELLED BEFORE <br />20 CNk CenterPlaaa, M-36 THE EXPI N DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIERDRRARESRNTATNR <br />of Matah Risk Is Insurance Senieea <br />RosalyndaManinez %k."TrIli sTlamareb®w"e <br />M d9a8.1D4a ACCRn CORPMRATION_ Ali rtnhaw rw .w col <br />ACORD 25 (2018102) The ACORD name and logo are registered marks of ACORD <br />
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