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PSOMAS, INC. (4)
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Last modified
9/25/2019 12:20:15 PM
Creation date
9/12/2019 3:36:57 PM
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Contracts
Company Name
PSOMAS, INC.
Contract #
A-2014-224-02
Agency
Public Works
Council Approval Date
9/16/2014
Expiration Date
8/31/2020
Insurance Exp Date
10/15/2019
Destruction Year
2025
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7 0 DATE (MMIDDNYYY) <br />acaKo CERTIFICATE OF LIABILITY INSURANCE <br />��. 9/19/2019 <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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />Dealey, Renton & Associates PHONE —1 FAX <br />Lic. #0020739 tac. Nn. ExtI. 714 427-6810 1 IAIC, No): 714 427-6818 <br />600 Anton Blvd., Suite 100 ADDRESS: -- <br />Costa Mesa CA 92626 INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: XL SDecialty Insurance Co. 37885 <br />INSURED PSOMAS <br />PSOMAS <br />555 South Flower Street, Suite 4300 <br />Los Angeles CA 90071 <br />INSURER B : <br />INSURER C : <br />INSURERD: <br />INSURER E : <br />INSURERF: <br />!`A►IGRAf.RC rFRTIPIrATF NIIMRFR• 1RA9RAR77 RFVIRI(iN NIIMRFR' <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 />NSR TR TYPE OF INSURANCE INSD SUER POLICY NUMBER MWDDIYY IYY MMIDD/YYYY LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />CLAIMS -MADE ❑ OCCUR <br />1GIAE TO RIENTED <br />PREMISES Ea acurrenc <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />QEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />PRODUCTS - COMP/OP AGG <br />$ <br />PRO- <br />POLICY l.1 JE C LOC <br />$ <br />OTHER; <br />AUTOMOBILE LIABILITY <br />COMBINEDINGLE MI <br />a +7CCk1 t <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />$ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />I <br />PROPERTY J)X GE <br />d <br />$ <br />_(PoLac <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ <br />PER OTH- <br />T T <br />E-L. EACH ACCIDENT <br />$ <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L_ DISEASE - POLICY LIMIT <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Professional Liability <br />Claims Made <br />DPR9932582 <br />10115/2011 <br />11115/2019 <br />Per Claim $1,000,000 <br />Annual Aggregate $2.000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />2SAN410111; Walnut Pump Station Upgrade Project / Agreement No.= A-2014-224 <br />REVIEWED & APPROVED <br />By RISC MANAGEMENT DIVISION <br />ULK I II-IUA It HULUtK f I ■ h r,) I ) I/A A r � 01 ll t-ANUrL.L.A 1 IUN au UaY INOUCe DI UanCellailOrl <br />FI2ANC:INE R. VILLAREAL <br />City of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />
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