|
CITYG-1 OP ID: DC
<br />'`'�Ca ►�. CERTIFICATE OF LIABILITY INSURANCE
<br />ATE(M6
<br />09111201 YY)
<br />r12019
<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 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 Ileu of such endorsements).
<br />PRODUCER
<br />Licensen#OC42488 Agency, Inc.
<br />4401 Hazel Avenue, Suite 110
<br />Fair Oaks, CA 95628
<br />CONTACTCummins Insurance Agency
<br />A M E,tt:916-961-6000 ,vc N,:916-961-3046
<br />E-MAIL
<br />ADDRESS: debbiec cumminsinsurance.com
<br />Cummins Insuraltce Agency, Inc
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC I
<br />INSURERA:Sentinel Insurance Company Ltd
<br />11000
<br />INSURED Citygate Associates, LLC
<br />INSURERB: Hartford Ins Co of the MidW
<br />37478
<br />David Deroos
<br />600 Coolidge Drive, Suite 150
<br />INSURERC: Landmark American Ins. Co.
<br />33138
<br />Folsom, CA 95630
<br />INSURERD:
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2
<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 />POLICY NUMBER
<br />POLICY F
<br />MMiDMY.
<br />I E
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,00
<br />CLAIMS -MADE � OCCUR
<br />X
<br />X
<br />57SBAAZ1255
<br />07/15/2019
<br />07/15/2020
<br />PREHS_DAMASES E itrance)$
<br />1,000,00
<br />X
<br />ritnary/Non-Contr
<br />MED EXP (Any one person)
<br />$ 10,00
<br />PERSONAL & ADV INJURY
<br />$ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,00
<br />POLICY JJECT PRO- FLOC
<br />PRODUCTS- COMPlOP AGG
<br />$ 4,000,00
<br />$
<br />OTHER
<br />AUTOMOBILE
<br />LIABILITY
<br />EMe91dtl!"-eAnSINGLELIhIIT
<br />$ 2,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />X
<br />57SBWI255
<br />07/15/2019
<br />07/15/2020
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />fa}tGPERTYR AGE
<br />tar accident
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,00
<br />AGGREGATE
<br />$ 4,000,00
<br />,A
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />57SBAAZ1255
<br />07/15/2019
<br />07/1512020
<br />DED I X I RETENT10N $ 10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />N I A
<br />X
<br />57WECEU6620
<br />10101,12019
<br />1010112020
<br />OTH-
<br />X STATUTE ER
<br />E L EACH ACCIDENT
<br />$ 1,000,000
<br />E L DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE - POLICY LIMIT
<br />1 $ 1,000,000
<br />C
<br />Professional Lia.
<br />LHR774429
<br />02/14/2019
<br />02/14/2020
<br />aggregate 2,000,00
<br />E&O
<br />occur 2,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Additional Insured: The City of Santa Ana, its officers, agents, and REVIEWED & APPROVED
<br />employees in regards to the General Liability as per the attached. Primary
<br />& Non -Contributory per attached Form SS 00 08 04 05. (30) Days Notice of By Risk MANACiFMENT DIVISION
<br />Cancellation as per attached Form SS 12 23 06 11.
<br />P24Z09
<br />CERTIFICATE HOLDER CANCELLATION ri[lily� tlrr_ 1%. ",
<br />SANTA22
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th FI
<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 />
|