My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
25A - AMEND AGMT FOR HELPMATES STAFFING
Clerk
>
Agenda Packets / Staff Reports
>
City Council (2004 - Present)
>
2020
>
09/15/2020
>
25A - AMEND AGMT FOR HELPMATES STAFFING
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/10/2020 5:10:17 PM
Creation date
9/10/2020 4:44:18 PM
Metadata
Fields
Template:
City Clerk
Doc Type
Agenda Packet
Agency
Human Resources
Item #
25A
Date
9/15/2020
Destruction Year
2025
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
49
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
10 <br />�Ze <br />A� CERTIFICATE OF LIABILITY INSURANCE DATE/(MM/DD� <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 confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Assurance Agency, Ltd <br />1750 E Golf Road <br />Suite 1100 <br />Schaumburg IL 60173 <br />CONT CT <br />Samantha Meccia <br />PHONE IF <br />312-625-5957 A/c Na: 647 440-9126 <br />noorsess, smeccia assurances enc .com <br />INSUl AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Zurich American Insurance Cc <br />16535 <br />INSURED TRUSTEM-01 <br />Trust Temporary Services, Inc, dba Helpmates Staff <br />1200 Main Street <br />INSURER B: American Guarantee & Llab <br />26247 <br />INSURER C: American Zurich Insurance Cc <br />40142 <br />INSURER D: Columbia Casualty Co <br />31127 <br />Suite A <br />Irvine CA 92614 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 1246622476 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 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY) <br />POLICY EXP <br />(MMMDNYYYI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LABILITY <br />PRA969865506 <br />4/1/2018 <br />4/1/2019 <br />EACH OCCURRENCE <br />$1,0 mo <br />X I CLAIMS -MADE OCCUR <br />DAMAGETORE TED <br />PREMISES Ee occunence <br />$100,000 <br />MED EXP (Any one person) <br />$10,000 <br />PERSONALBADVINJURY <br />$1.000,000 <br />GEN'L AGGREGATE LIMIT APPLES PER <br />GENERALAGGREGATE <br />$3,000.000 <br />X POLICY JEC LOC <br />PRODUCTS-COMP/OPAGG <br />$2.000.000 <br />$ <br />OTHER: <br />A <br />A <br />AUTOMOBILE <br />LIABILITY <br />BAP591335304 <br />PRA969865506 <br />4/1/2018 <br />4/1/2018 <br />4/1/2019 <br />4112019 <br />COMBINED SINGLE LIMIT <br />Es accident <br />$1,000.000 <br />BODILY INJURY (Per person) <br />$ <br />AUTO <br />OWNED SCHEDULEDAUTOS ONLY AUTOSBODILY <br />JANY <br />INJURY (Per accident) <br />$ <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE <br />Per accident) <br />$ <br />B <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />UMBM720206 <br />4/1/2018 <br />41IM019 <br />EACH OCCURRENCE <br />$5.000.000 <br />AGGREGATE <br />$5,000.Wo <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I X I RETENTION$o <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />WC557130705 <br />8/92017 <br />8/92018 <br />X STATUTE ERH <br />E.L. EACH ACCIDENT <br />$1,00000o <br />ANYPROPRIETOWPARTNEWEXECUTIVE N] <br />OFFICER/MEMBEREXCLUDED? <br />NIA <br />E.L. DISEASE -EA EMPLOYEE <br />$1000,000 <br />(Mandatory In NH) <br />If yes, tlescrib. antler <br />DESCRIPTION OF OPERATIONSbelow <br />E.L. DISEASE -POLICY LIMIT <br />$1000.000 <br />A <br />A <br />D <br />Crme(3rd Party) <br />Professional Liability <br />Cyber Liability <br />PRA969865506 <br />PRA969865506 <br />596881085 <br />4/12018 <br />411MO18 <br />4/1/2018 <br />V12019 <br />W12019 <br />4112O19 <br />3,000,000 Umil <br />$2MM ecc. /$4M agg <br />Agg:$1.000.000 <br />5,00 Ded. <br />25,000 Ded. <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />It is agreed that the following are added as Additional Insured, when required by written contract, on the General Liability with respect to operations performed <br />by the Named Insured in connection with this project: THE CITY OF SANTA ANA, ITS OFFICERS , EMPLOYEES, AGENTS, AND REPRESENTATIVE <br />City of Santa Ana <br />20 Civic Center Plaza <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 />AUTHORIZED REPRESENTATIVE <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and tSg Aei;f ged marks of ACORD <br />THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE 1 as <br />
The URL can be used to link to this page
Your browser does not support the video tag.