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Click here to clear Form <br />Glick here to Send Form <br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE <br />DATE (M <br />03/15/M/DD/YYYY) <br />03/15/2021 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />LIN ASSOCIATES INSURANCE AGENCY <br />24705 ASSOCIATES <br />I AVE, ANC <br />#200ALTER <br />LOMITA, CA 90717 <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />INSURERA: THE HARTFORD <br />29459 <br />CENTURY STRUCTURAL ENGINEERING CO. INC. <br />INSURERB: <br />24719 NARBONNE AVE <br />LOMITA, CA 90717 <br />INSURERC: <br />INSURER D: <br />INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />DD'L <br />INSRD <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />VE <br />POLICYEFFECTI/YY <br />DATE MM/DD <br />POLICY EXPIRATION <br />DATE MM/DDY <br />/Y <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />. CLAIMS MADE M. OCCUR <br />EACH OCCURRENCE <br />$ <br />0 <br />PREMI ETORENTED <br />PREMISES Ea occurence <br />$ <br />MED EXP (Any one person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GENERALAGGREGATE <br />$ <br />GEN'LAGGREGATE LIMIT APPLIES PER : <br />POLICY PRO LOC <br />JECT <br />PRODUCTS - COMP/OP AGG <br />$ <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULEDAUTOS <br />HIREDAUTOS <br />NON-OWNEDAUTOS <br />0 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY <br />(Per person) <br />BODILY INJURY <br />(Per accident) <br />$ <br />$ <br />0 <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />GARAGELIABILITY <br />ANY AUTO <br />AUTO ONLY - EAACCI DENT <br />$ <br />OTHEHAN EA ACC <br />AUTO O <br />AUTO ONLY: AGG <br />$ <br />PESS/UMBRELLA <br />$ <br />LIABILITY <br />P OCCUR ED CLAIMS MADE <br />DEDUCTIBLE <br />RETENTION $ <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />$ <br />$ <br />$ <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />57WECDW3167 <br />01/18/2021 <br />01/18/2022 <br />✓ <br />ORY LIMITSOTH- <br />ER <br />E.L.EACHACCIDENT <br />$ 1,000,000 <br />F <br />E.L. DISEASE- EA EMPLOYEE <br />$ 1,000,000 <br />r <br />E.L. DISEASE- POLICY LIMIT <br />$ 1,000,000 <br />OTHER <br />0 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />FOR EVIDENCE OF COVERAGE ONLY DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN <br />CITY OF SANTA ANA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />RISK MANAGEMENT DIVISION IMPOSE NO OBLIGATION OR LIABILITY OF AN <br />20 CIVIC CENTER PLAZA, 4TH FLOOR f:.. <br />SANTA ANA, CA 92701 RTHORIZ ID RE ,RE _ _ j�jgk�{jaryjajpn <br />AUTHORIZED REPRESEN A21VE <br />z REVIEWED & APPROVED BY. <br />LIN ASI,SOCIATES-ICJ A F 1 VSA44a '. <br />ACORD 25 (2001/08) T t J/ `' Risk Management Analyst <br />