|
Client#: 1778682
<br />CBGENERHOL
<br />ACORD.,, CERTIFICATE OF LIABILITY INSURANCE
<br />OATE (.MlD.1yyV)
<br />310312020/2020
<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 AOOITIDNAL 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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CO CT
<br />NAME:SI
<br />UInsurance Services LLC PHONE EXU513 852.6300
<br />AIC : c 513 852-6428
<br />___ AINo:
<br />IL
<br />312 Elm Street, 24th Floor ! nooss:
<br />ne
<br />Cincinnati, OH 45202-- ----
<br />INSURER(5)AFFORDINGCOVERAGE NAIC9
<br />513852-6300
<br />INSURER A : qaE wwonce aarpvmno^ 39217
<br />INSURED Galls, LLC I INSURER B: auneraIC.... 11 p-m ,ul msconeln
<br />24414
<br />3]25]
<br />INSURER C : Praolounn Insu,am. cammny
<br />Russell Cave Road
<br />10677
<br />,,p
<br />LINSURER D: The CI-Ims ll.,—cc,nny
<br />Lexington,
<br />Lexington, KY 40505
<br />37532
<br />INSURER E: u°m A—n-e a as lmamm,. c—n.ny
<br />INSURER F:
<br />CERTIFICATE a NUMBER; 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 CONTRACTOR 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 />MO
<br />TYPE OF INSURANCE
<br />ADDL BUBRI
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDO/YYYY
<br />POUCYEXP--
<br />MMRIINYVYY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY ! X
<br />X 11 „f.`GA1365959
<br />03/0112020
<br />03/01/2021 EACH OCCURRENCE
<br />$1 wom00
<br />— CLAIMS-MIADE X OCCUR
<br />DAMAGGEE TO RENTED
<br />PREMISES IEa ouvrrencel
<br />S1000000
<br />S101000
<br />MED EXP(Any aneperser
<br />S1,000 OOO
<br />PERSONAL B ADV INJURY
<br />GENL
<br />AGGREGATE LIMIT APPLIES PER
<br />I_- JECT
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />S2,000r000
<br />POLICY I ! LOC
<br />PRODUCTS - COMPIOP AGO
<br />OTHER:
<br />s
<br />A
<br />AUTOMOBILE
<br />LIABILITY X
<br />X .CBA1365959
<br />03/0112020
<br />03101/2021, EOM'",dapDSiNGLE LIMB
<br />s1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY(Perpersan)
<br />$
<br />OWNED SCHEDULED
<br />5
<br />AUTOS ONLY AUTOS -
<br />BODILY INJURY(Peratuden)
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERTY DAMAGE
<br />I W., acciden)
<br />S
<br />B
<br />X
<br />U41BRELLA LIAR
<br />X iOCCUR
<br />CCU1365959
<br />03/01/2020
<br />03101/2021 EACH OCCURRENCE
<br />31.0 OOO OOO
<br />EXCESS LIAR
<br />CIAIMS-MINDE
<br />AGGREGATE
<br />310 00O O00
<br />DELI X P,ETENTION31O 000
<br />3
<br />U
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERTLIABILITY
<br />I
<br />ICWC1365959
<br />03/0112020
<br />03/01/2021 X PrR IDT"-
<br />YIN
<br />ANY PROPRIUMPARTNEM'EXECUTIVE
<br />OFFICERRrIEMBER EXCLUDED?
<br />NIA
<br />E.L. CACH AGCIpENT 51,000 OOO
<br />(Mandatory In NH)
<br />uncle
<br />EL DISEASE -EA EMPLOYEE s1,000,000
<br />TONcribe
<br />DESCRIPTION OF OPERATIONS bela,r
<br />DES11 CRIPTION
<br />E.L. DIS'cASE- POLICY LIMIT $1,000,000
<br />D
<br />Excess Liability
<br />EXS0570374
<br />310112020
<br />0310112021. $15,000,000 Limit
<br />E
<br />E
<br />Pollution
<br />PREE29196800
<br />01/31/2018
<br />01131/2021 $3,000,000 Limit
<br />O ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mare space is required)
<br />RE: RFP 19.104.
<br />The General Liability and Automobile Liability policies includes an automatic Additional Insured
<br />endorsement that provides Additional Insured status to City of Santa Alia, its officers, employees, agents
<br />and representatives, only when there is a written contract that requires such status, and only with regard
<br />to work performed on behalf of the named Insured. The General Liability policy contains a special
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza 4th F
<br />Santa Ana, CA 92701
<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 />O 1988-2015
<br />ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S28128195/M28117946 PCAZP
<br />off einine-------I
<br />
|