|
Francine R. n1g�rally59r dby r,eouoeR
<br />V/illorcal uale,�l
<br />ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YYYY)
<br />11/11/2020
<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 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 endorsement(s).
<br />PRODUCER
<br />(BK) Heffernan Insurance Brokers
<br />7702 Meany Ave., Suite 102
<br />Bakersfield CA 93308
<br />CONTACT
<br />NAME: Kariss Perry
<br />PHONE FAX
<br />No.Eat: 661-489-7380 AIC Ne:415-778-0301
<br />emA
<br />ADDRESS: karissp@heffins.com
<br />INSURER($) AFFORDING COVERAGE
<br />NAIC#
<br />INSURERA: Federal Insurance Company
<br />20281
<br />License#: 0564249
<br />INSURED APPLTEC-03
<br />Applied Technology Group Inc
<br />4440 Easton Drive
<br />INSURER B: Insurance Company ofthe West
<br />27847
<br />INSURER C: Scottsdale Indemnity Company
<br />15580
<br />INSURER D:
<br />Bakersfield CA 93309
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 129189129 REVISION NUMBER:
<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 />OF INSURANCE
<br />ADDLSUBRTYPE
<br />INSD
<br />W/D
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICYEXP
<br />MMIDDYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />V
<br />36025222VVCE
<br />7/1/2020
<br />7/1/2021
<br />EACH OCCURRENCE
<br />$1,000,000
<br />Cl-AIMS-MADE 1XI OCCUR
<br />DAMAGE PREMISES Ea occurrOence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL&ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />Fyl POLICY PEP LOC
<br />PRODUCTS-COMP/OP AGO
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />2073584639
<br />7/1/2020
<br />7/1/2021
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$1,000,000
<br />X
<br />BODI LV I NJURY(Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTO$
<br />BODILY INJURV(Per accident)
<br />$
<br />X
<br />HIRED N NON -OWNED
<br />AUTO$ ONLY AUTO$ ONLY
<br />PROPERTY DAMAGE
<br />Per accitlenl
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />79894822
<br />7/1/2020
<br />7/1/2021
<br />EACH OCCURRENCE
<br />$5,000,000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />VVPL503611603
<br />3/22/2020
<br />3/22/2021
<br />X PER GTH-
<br />STATUTE ER
<br />ANYPROPRIETOMPARTNER/EXECUTIVE
<br />EL EACH ACCIDENT
<br />$1,000,000
<br />OFFICER/MEMBEREXCLUDED9 ❑
<br />N/A
<br />E. L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If as, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />C
<br />Proffesional Laibility
<br />EK13354264
<br />11/19/2020
<br />11/19/2021
<br />Per Claim &Agg
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Re: As Per Contract or Agreement on File with Insured. The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as
<br />an additional insured (primary and non-contributory) on General Liability policy per the attached endorsements, if required. Cancellation notice endorsement for
<br />General Liability is attached, if required.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division, 4th Floor
<br />20 Civic Center Plaza
<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 />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />Risk Managment Diuisian
<br />ram.
<br />REVIEWED &{APPRcZvED By.,
<br />olllli111-1� /-z' rb6HlM�e UsRRE/t¢bl.
<br />® Risk Management Analyst
<br />
|