Laserfiche WebLink
CERTIFICATE OF LIABILITY INSURANCE °aTE(MM/DD/ryryi <br />THIS CERTIFICATE IS ISSUED qS q 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 THESPOULICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ORDERINSURR(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the <br />terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsemen Policies <br />PRODUCER RICHARD H. VOSSMEYER, AGENT <br />ONTA T <br />LICENSE #: 0532861 NAME: RICHARD H. VOSSMEYER <br />PHONE <br />StateFarlrr 2722 FOOTHILL BLVD EMAIL 816 94s 44 3 F C No : 818 949 427 <br />LA CRESCENTA, CA 91214 aD°REss: RICHARD.VOSSMEYER.BSRZ STATEFARM.COM <br />INSURED VIDO SAMARZICH, INC. <br />6829 BILLINGS PL <br />RANCHO CUCAMONGA, CA 91701-1260 <br />_.. -� -1-WGAN- - _• _ wrawry NUMBER: <br />THE INSU <br />Y REQUIREMENT, TERM OR CONDITION OF ANY CONTI? CTOOR <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />XCLUSIONS <br />0 HER DOCUMENTAWITH RESPECT TC <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY <br />INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN <br />TYPE OF INSURANCE <br />D LS B IS SUBJECT TO ALL <br />HAVE BEEN REDUCED BY PgID CLAIMS, <br />GENERAL LIABILITY <br />POLICY NUMBER POLICY EFF POLICY p <br />❑ MM/DD/YVyy MNIIDDlYYYY <br />COMMERCIAL GENERAL LIABILITY <br />LIMITS <br />CLAIMS -MADE ❑ OCCUR <br />EACH OCCURRENCE $ <br />PREMISES Be occunence $ <br />MED EXP (Any one person) $ <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />PERSONALS ADV INJURY $ <br />POLICY PRO- <br />GENERALAGGREGATE $ <br />LOC <br />AUTOMOBILILELIABILITY <br />PRODUCTS-COMPfOP qGG $ <br />ANY AUTO <br />NED <br />Y ❑ 456 4465-B06-75 $ <br />04/16/2019 04/12/2020 COMBINED ING E LI IT <br />Ea acGden1 <br />AUTOS X SCHEDULE° <br />AUTOS <br />X HIREDAUTOS X gUT03�E0 <br />$ <br />BODILY INJURY(Perpereon) $ <br />5164139-EO9-75A <br />01/17/2019 01/17/2021 BODILY INJURY (Per accdent) $ <br />UMBRELLA LIAB <br />PR PERTY DAMAGE <br />Per accident $ <br />OCCUR <br />EXCESS LIAB <br />YfN <br />EDIWA <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AUach ACORD 101, Additional Remarks Schedule, Project No, 19-7528 Residential Street Repair Program If more apace Is required) <br />City of Santa Ana, its officers, employees, agents and representatives are Additional Insureds with respect to auto liability per the attached endorsement as <br />required by the written contract. Insurance is Primary and Non -Contributory, p <br />30 Day Notice of cancellation with 10 days notice for non-payment of premium In accordance with the policy provisions. <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />Risk Management <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED <br />r*NDTTTHEREOF, NI <br />-a BE CAP <br />WILL BE <br />TERMS, <br />IN <br />ACORD 25 (20101 The ACORD name and logo are registerep marks of <br />132849.8 01-23-2013 <br />