|
rranClne K. Francine R Villareal
<br />Date: 1020.09.02
<br />Villareal
<br />10:18:53-07'00'
<br />"� o CERTIFICATE OF LIABILITY INSURANCE
<br />DAToe/�so20 Y)
<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(les) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Aon Risk services Northeast, Inc.
<br />New York NY Office
<br />One Liberty Plaza
<br />165 Broadway, Suite 3201
<br />New York NY 10006 USA
<br />CONTACT
<br />NAME:
<br />INC. No.Exg: (866) 283-7122 FAX (800) 363-0105
<br />A C. Na.:
<br />EMAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC k
<br />INSURED
<br />LOS Angeles 5MSA LP
<br />dba verizon Wireless
<br />INSURERA: National Union Fire Ins Co of Pittsburgh
<br />19445
<br />INSURER B: AIU Insurance Company
<br />19399
<br />1095 Avenue of the Americas
<br />New York NY 10036 USA
<br />INSURER C: American Home Assurance Co.
<br />19380
<br />INSURER D: New Hampshire Insurance Company
<br />23841
<br />INSURER E:
<br />INSURER F:
<br />rnvconr_cc ..r-..r,�,...��..------- -------...,.--
<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. Limits shown areas requested
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />FULIUY
<br />MMIDDIYYYY
<br />MMIDDn'YYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />Y
<br />Y
<br />GL
<br />EACH OCCURRENCE
<br />$2,000,003
<br />A E ENTED
<br />PREMISES Ea occurrence
<br />$2, 000, 000
<br />X
<br />MED EXP (Any one person)
<br />$10, 000
<br />XCU Coverage is Included
<br />PERSONAL a ADV INJURY
<br />52,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO-
<br />X POLICY JECT LOC Fl
<br />GENERALAGGREGATE
<br />$5,000,000
<br />PRODUCTS -COMPIOPAGG
<br />$5,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />CA 4594298
<br />AOS
<br />06/30/2020
<br />06/30/2021
<br />COMBINED SINGLE LIMIT
<br />Ea acEdeno
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />A
<br />X ANYAUTO
<br />CA 4594299
<br />06/30/2020
<br />06/30/2021
<br />A
<br />OWNED SCHEDULED
<br />AUTOS
<br />REDAUOTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />MA
<br />CP. 4594300
<br />VA
<br />06/30/2020
<br />06/30/2021
<br />BODILY INJURY (Par acadeng
<br />PROPERTY DAMAGE
<br />Per accident
<br />A
<br />See Next Page
<br />06/30/2020
<br />06/30/2021
<br />UMSRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />DED1
<br />RETENTION
<br />B
<br />L,
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR I PARTNER I EXECUTIVE N
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />NIA
<br />WC045886576
<br />ADS
<br />WC045886575
<br />CA,
<br />06/30/2020
<br />06/30/2020
<br />06/30/2021
<br />06/30/2021
<br />X PER STATUTE
<br />OTH-
<br />ER
<br />E L. EACH ACCIDENT
<br />$1, 000,000
<br />E.L. DISEASEEAEMPLOYEE
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attached M more space is required)
<br />The above -referenced General Liability policy shall cover the tort liability of the Certificate Holder assumed under the�i
<br />underlying agreement between parties for which the certificate has been issued. City of Santa Ana, its council members,
<br />officers and employees are included as Additional Insured with respect to the General Liability policy. The General Liability I'I policy shall apply as Primary and Non -Contributory Insurance to each Additional insured listed herein. Where permitted 6y law,
<br />the Named Insured parties listed herein waive all rights against City of Santa Ana, its council members, officers and employees
<br />listed herein for recovery of damages to the extent these damages are covered by the above -referenced General Liability policy
<br />and, as further limited by written contract between the parties.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana CA 92701 USA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />LPIL'D1;)r�y0
<br />l „J
<br />e
<br />c
<br />V
<br />0
<br />O
<br />2
<br />©1988-2015 ACORD
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />REVIEWm 6 APPROJD BY:
<br />F-U'Wn-K Z vj&4 "
<br />RMk Management Analyst
<br />
|