|
Page 1 of 2
<br />CERTIFICATE OF LIABILITY INSURANCE D03/03/2020ATE Y
<br />os/D3/zozo
<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 POiicy(ies) must have ADDITIONAL INSURED provisions or ba 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 />Willis Towers Watson Insurance Services West, Inn.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />Naahv111e, TN 372305191 USA
<br />INSURED
<br />Acekalian Hntarprlaea Tao dba Athens Sasvioes
<br />14048 Valley Blvd.
<br />City Of Industry, CA 91746 USA
<br />Willie Towers Watson Certificate Cent"
<br />1 871- 7-945 7378 1 888 467 2378
<br />MI_ _ A1G N3L_.
<br />aertificatos6wi11is. com _ _
<br />INSURERS ) AFFORDINGCOVERAG .�, HAIC9
<br />AID .Specialty Insurance Company 26883
<br />I; GraunwicB Insurance Company 22322
<br />Berkshire Hathaway Specialty lUsuranue Ono 22276
<br />..._._m_.........._.....__..______._.____._..._. . ._._._._.
<br />;; Xb Insurance America Inc 24554
<br />COVERAGES CERTIFIf:ATF N[IMRFR- W15662201 orA/ICIAM K111"Ora•--_-_--
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION 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'�_."'^''�"����_'��. OD 9U8R®`..""._._____� PICYEFP' POLICY EXP-`. ... ........._.___..._._.T. ,.,_,�,
<br />L TYPE OF INSURANCE P LICYN MBER MIDDIWYY ! M DD LIMITS
<br />X COMMBRCLALGENERALLIABILITY
<br />_�..
<br />I EACH OCCURRENCE
<br />•S 11000,000
<br />1 OLAIMS MADE ;?t OCCUR
<br />I"DAF,TAatF8 AENTEn
<br />i
<br />3 304,000
<br />�I
<br />PREMISES tEe zrcexlrtenapj
<br />-..
<br />A
<br />( )
<br />MEO ESP (An' ore person)
<br />3.. 25,000
<br />I
<br />ED 6439324 103 Ol(242q ;03l01l2021
<br />PERSONAL A now INJURY !F
<br />1.00q,000
<br />BE' AGGREGATE LIMIT APPLIES PER: I
<br />r�
<br />POLICY X. Ja
<br />!
<br />O EEN�RALAGOREGATP
<br />C_ __Me
<br />_......
<br />_S20000_0_0
<br />_
<br />S 2,000 000
<br />OTHER:
<br />I
<br />~
<br />I AUTOM091LELIAWLITY i
<br />ANY AUTO
<br />Ee yB�doliNEDrSIN LE LIMIT
<br />L_..___......._.-__
<br />BODILY INJURY (Par 4arspnl
<br />S S,O0O,000
<br />S
<br />B
<br />OWNED SCHEDULED
<br />�..
<br />r,r AUTOS ONLY -��. AUTOS ''.
<br />RADS00042706 03l01/2020 03/01/2021I--OILY
<br />!
<br />INJURY------- 1
<br />MIRED ! NONAWNEO
<br />AUTOS ONLY �__ AUTOS ONLY
<br />IL PH PERTYOAMAOE
<br />I (Par eSGdgstj _
<br />_
<br />$
<br />C
<br />I UMBRELLA LIAR I %< OCCUR
<br />i
<br />EACH OCCURRENCE
<br />-.S 51000,000
<br />-X
<br />EXCESS HAS I )CWh15,AAAE
<br />, 42-4ti0-3i0383-01 43/O112020.03/01/2021
<br />AGGREGATE
<br />$ 51000,000
<br />Y— ....._..,.
<br />1 X I 25,000
<br />4
<br />-•D RETENTIONS
<br />WORKHRSCOMPENSATION
<br />AND EMPLOYBRB'LIAOILnY YIN -
<br />!
<br />X
<br />)_ ! STATE ORH•___
<br />k
<br />D
<br />AHYPROPRIETO"ARTNEIVEXECURVE
<br />OFFIGERMEMNNtAI
<br />i RMS00042608
<br />EL�EACH ACCIDENT
<br />lb4O,044
<br />---
<br />(MmuktoryinNH)
<br />I !
<br />. E.L. OISEASE•EAEMPLOYEE�S
<br />1,000, 000
<br />yes 4acnba
<br />davAbN
<br />_
<br />OE66I OF'Q 814w
<br />OF-PERATIONS 4fit
<br />EL D15EASH_POLICY UAI
<br />$$
<br />DESCRIPTION OFOPERATIONS I LOCATIONS!VEHICLES (ACORD t01,Addidona1 Ramada Sehedule, may so AmIIhed Has. aR Ia Is raau1nd)
<br />This Voids and Replaces Previously Issued Certificate Dated 03/03/2020 WITH ID: W15639490.
<br />Project: #11-6743, Broadway Rehabilitation -Civic Center Drive to Santa Clara Ave and 11-6415 Broadway and Washington
<br />Ave.
<br />City of Santa Ana, officers, agents, employees, and volunteers are included as an Additional Insured as respects to
<br />R I VIEWEA&APPROVIED
<br />Bi Ris1(M1UNIi,1iENlENr DivisiON
<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 />� 2jjv20
<br />City of Santa Ana `F
<br />AUTHORIEEO REPRESENTATIVE
<br />.Risk Management Division
<br />20 Civic Center Pla;a, 4th flog
<br />s> MAN111A M. LAMBERT
<br />tGtf t't�...---•
<br />Santa "a, CA -----
<br />0 1988.2016 ACORD CORPORATION, All rights reserved.
<br />ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />an In: 19340035 9ATCK: 1601253
<br />
|