|
DATE (MWDDYYYY)
<br />CERTIFICATEF LIABILITY INSURANCE 03/28/2020
<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 conifer rights to the certificate holder in lieu of such end'orsement(s).
<br />PRODUCER 1-214-363-4433 CONTACT Austin Strain...
<br />Holmes Murphy & Associates NAME:. _.... ..... FAX
<br />ONE
<br />265-2262 (ABC' Nu . ..
<br />IABC.No.Eztl: 214 _.... 214-346-6775'
<br />E-MAIL ..'""".'.`..
<br />12712 Park Central Dr., Suite 100 ADDRESS: AStrain@holmesmurphy.com
<br />National as TX 75251 .,..,.... INSUgRA,;, CRUM & FOR TER SPECIALTY' INS CO .. ..,44520
<br />Dallas,
<br />rr
<br />INI
<br />INSURED INSURER B : 24074
<br />Corrosion
<br />5450 Katella Avenue INSURERD:
<br />INSURER E
<br />Los Alamitos, CA 90720 INSURERF:
<br />CC1VFRAr.F.q rI=PTtPIrATF NIIIIu1RF:Q- 5RgD5Ar,4 ocraieone.� hri Anamin....
<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 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILNSRF TR TYPEOF INSURANCE .. A SD WVD POLICY NUMBER MM/DDYYYY 'MDDLISUBRI MIDDIY XP
<br />D!Y`(YY LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EPK127203...
<br />06/08/19
<br />06/08/20
<br />EACHOCClJRRENCE
<br />S 2,000,000
<br />[7AIMAUE I'O RENTECI
<br />... CLAIMS-CLAIMS-MADEX OCCUR
<br />WRI-MISLSILa vccaurec�ce
<br />S 50,000
<br />..._._.,.,.._.._
<br />MED EXP (Any one p&son)y
<br />$ 5,000
<br />-
<br />PERSONALY AOV INJURY
<br />5 2,000,000
<br />GEN'L A{,GRECA FE LIMH APPLIES PER
<br />GENERAL AGGREGATE
<br />S2,000,000
<br />X POLICY I E'C'J-
<br />PRODUCTS - COMPdOPAGG
<br />S 2,000,000
<br />ETHER
<br />$
<br />E
<br />AUTOMOBILE
<br />LIABILITY
<br />BAS59138890
<br />0,6/08/1.9
<br />06/08/20
<br />COMBINED SINGLE. LIMIT
<br />s
<br />Eaaccidm[I
<br />1..,000,000
<br />X
<br />ANY AUTO
<br />BODILY IN.i I.IRY IPer persnnl
<br />S
<br />_.._
<br />OWNED SCHEt7UiLED
<br />AU ICYS ONLY AtJT05
<br />....... ......_.
<br />BODILY IIN.JURK Per aceldent
<br />I Y
<br />-... ........
<br />....
<br />s
<br />TRIED NC7N-4TV4+NFD
<br />.-LR ... �.._.-a.
<br />I'RS}F'"fYCY<tMAGF.
<br />....... .. ......_
<br />S
<br />ALP FOS ONLY AU T'OS ONLY
<br />.Per accidenlp
<br />s
<br />A
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EFX112924,
<br />06/08✓19
<br />06/08/20
<br />EACH OCCURRENCE
<br />s 8,000,000
<br />x
<br />EXCESS LIAR
<br />CLAIMSMAnF'...,
<br />AGGREGATE:
<br />g 8,000,000
<br />DEL) RETENTION $
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />xPi�TS59138890..
<br />06/D8/19
<br />06/08✓2D
<br />X STATtITfm=.._., ©RH
<br />Y / N-_
<br />ANYPRCY'PRIE 10R.fPARTNER"EXECAJIIVL
<br />F E,hCH', ACCIDENT
<br />.-----..
<br />,p 1,0 00. 40D
<br />OFFIICFRBMEMBEREXCLUDEDI
<br />N 1 A
<br />E..L.UISLASE-EAEMPLUYEE
<br />-- -
<br />$ 1,000,000
<br />(MandatauylnNFf�l
<br />If yes, describe under
<br />E.IL DISEASE-POLICYLVMIT
<br />$ 1,000,000
<br />DESCRIPTIONOFOPIERAHUNSl)Oow
<br />A
<br />(Errors & Omissions
<br />EPK127203
<br />06/08/19
<br />06/08✓20
<br />Ea Wrongful Act
<br />2,000,000
<br />A
<br />'Pollution Liability
<br />I
<br />EPK127203
<br />06/08/19
<br />06/08/20
<br />Each Pollution
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS d LOCATIONS 8 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The certificate holder is amended to include City of Santa Ana, officers, agents, employees, and volunteers pursuant to
<br />the Written. Contract with the named ensured.
<br />t"A
<br />See Supplemental.
<br />RaJEWED iwsy�t(�N
<br />tN7',.'•�rl'7rM:7rR�=rf�l�l�7'iL' C �1�'Ri'�S�iLr '•."•'•' . ... . r .
<br />�
<br />tl�
<br />City of Santa Ana
<br />Risk Management Envision, 4th Floor � T � „,ff.
<br />I
<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 />20 Civic Center Plaz...a.
<br />Santa Ana, CA 92701
<br />USA
<br />AUTHORIZED REPRESENTATIVE
<br />, 1 < ;__ f....
<br />( 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered) marks of ACORD
<br />astraintx
<br />58905854
<br />
|