|
<br />#
<br />100,000
<br />NAIC
<br />Excluded
<br />reserved.
<br />1,000,0001,000,0002,000,0002,000,0001,000,0001,000,0005,000,0005,000,0001,000,0001,000,0001,000,000
<br />$1,000,000$1,000,000
<br />412972406616188350763892010200
<br />6/30/2020
<br />rights
<br />DATE (MM/DD/YYYY)
<br />$$$$$$$$$$$$$$$$$$
<br />(415)657-2002
<br />All
<br />LIMITS
<br />OTH-ER
<br />person)accident)
<br />FAX(A/C, No):
<br />person)
<br />INJURY
<br />(Per(Per
<br />occurrence)
<br />one
<br />ADV
<br />NUMBER:
<br />&
<br />(Ea
<br />ACCIDENT
<br />(Any
<br />INJURYINJURY
<br />OCCURRENCEOCCURRENCE
<br />CORPORATION.
<br />EXP
<br />COVERAGEPERSTATUTE
<br />accident)
<br />EACH
<br />accident)
<br />X
<br />EACHDAMAGE TO RENTEDPREMISESMEDPERSONALGENERAL AGGREGATEPRODUCTS - COMP/OP AGG Employee Benefits COMBINED SINGLE LIMIT(EaBODILYBODILYPROPERTY DAMAGE(PerEACHAGGREGATEE.L.E.L. DISEASE
<br /> - EA EMPLOYEEE.L. DISEASE - POLICY LIMIT Each Pollution Condition:Each Claim:
<br />REVISION
<br />ACORD
<br />AFFORDING
<br />ACORD
<br />7/1/20217/1/20217/1/20217/1/20217/1/20217/1/2021
<br />of
<br />POLICY EXP
<br />(MM/DD/YYYY)
<br />INSURER(S)
<br />1988-2014
<br />©
<br />marks
<br />(415)657-2000
<br />Scottsdale Insurance CompanyAmerican Fire and Casualty CompanyTrisura Specialty Insurance CompanyState Compensation Ins. FundKinsale Insurance CompanyHiscox Insurance Company Inc
<br />Fernando Rivasfernando@isuca.com
<br />7/1/20207/1/20207/1/20207/1/20207/1/20207/1/2020
<br />POLICY EFF
<br />(MM/DD/YYYY)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.
<br />registered
<br />CONTACTNAME:PHONE(A/C, No, Ext):E-MAILADDRESS:INSURER A :INSURER B :INSURER C :INSURER D :INSURER E :INSURER F :CANCELLATION AUTHORIZED REPRESENTATIVE
<br />Josh Ferenc/FR
<br />are
<br />logo
<br />and
<br />20-21 GL,WC,BA,XS,E&O,PL
<br />POLICY NUMBER
<br />name
<br />NUMBER:
<br />BCS0038754BAA (21) 58 05 63 03TXS 0001452-019063608-200100119060-0MPL1863490.20
<br />ACORD
<br />WVD
<br />SUBR
<br />The
<br />XX
<br />INSD N / A
<br />ADDL
<br />CERTIFICATE OF LIABILITY INSURANCE 9413492705
<br />Y / N
<br />CERTIFICATE
<br />CACA LOC
<br />OCCUROCCURCLAIMS-MADE
<br />$
<br />SCHEDULEDAUTOSNON-OWNEDAUTOS
<br />XX
<br />X
<br />PRO-JECT
<br />RETENTION
<br />under
<br />TYPE OF INSURANCE
<br />CLAIMS-MADE
<br />(2014/01)
<br />OWNED
<br />describe
<br />25
<br />COMMERCIAL GENERAL LIABILITYPOLICYOTHER:ANY AUTOALLAUTOSHIRED AUTOSUMBRELLA LIABEXCESS LIABDED
<br /> (201401)
<br />City of Santa AnaRisk Management Division20 Civic Center Plaza4th FloorSanta Ana, CA 92702
<br />yes,
<br />XXXXX
<br />GEN'L AGGREGATE LIMIT APPLIES PER:AUTOMOBILE LIABILITY Pollution LiabilityProfessional Liability
<br />WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED?(Mandatory in NH)IfDESCRIPTION OF OPERATIONS below
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER
<br /> THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE
<br /> CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of
<br /> the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).THIS IS TO CERTIFY
<br /> THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
<br /> OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS
<br /> AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ABCDEF
<br />PRODUCER ISU Insurance Services - Centinel Agency, LLC250 Executive Park BlvdSuite 4800San Francisco INSURED California Barricade Rentals Inc1550 E Saint Gertrude PlaceSanta Ana COVERAGES
<br /> LTR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)The City of Santa Ana, Risk Management, it’s
<br /> officers, employees, agents, representatives, and volunteersare named as additional insured per form CG 20 12 12 19 on the GL policy. Primary and Non-Contributorywording applies.Additional
<br /> Insured and Primary & Non-Contributory Wording applies per form AC 85 43 06 18 on the Autopolicy.CERTIFICATE HOLDERACORDINS025
<br />INSR
<br />
<br />
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