|
DATE(MM/DD/YYYY)
<br /> CERTIFICATE OF LIABILITY INSURANCE I
<br /> 09/04/2024
<br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS O
<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. C0
<br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 2
<br /> certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br /> PRODUCER CONTACT a
<br /> NAME:
<br /> AOn Risk insurance Services west, Inc.
<br /> LOS Angeles CA Office (A/C.N o.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105
<br /> 707 Wilshire Boulevard E-MAIL p
<br /> Suite 2600 ADDRESS: _
<br /> Los Angeles CA 90017-0460 USA
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURED INSURER A: LM Insurance Corporation 33600
<br /> ACCO Engineered Systems, Inc. INSURER B: Liberty Mutual Fire Ins CO 23035
<br /> 888 East Walnut Street
<br /> Pasadena CA 91101 USA INSURER C: American Fire & Casualty Co 24066
<br /> INSURER D: ironshore Specialty Insurance Company 25445
<br /> Digitally s gaulriby r—W 4m pany 39462Anqie Acevedo natp. qn9l" 11 _ r COVERAGE CERTIFICATE Nl3;dBER: 570108013570 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. Limits shown are as requested
<br /> LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS
<br /> B X COMMERCIAL GENERAL LIABILITY Y Y TB2661067353034 10 Ol 2024 10 Ol 2025 EACH OCCURRENCE $2,000,000
<br /> CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED $1,000,000
<br /> PREMISES Ea occurrence
<br /> MED EXP(Any one person) $5,000
<br /> PERSONAL&ADV INJURY $2,000,000
<br /> GEN'LAGGREGAATTE LIMITAPPLIES PER: GENERAL AGGREGATE $4,000,000 C')POLICY 1 X PE� �X LOC PRODUCTS-COMP/OP AGG $4,000,000 oo
<br /> OTHER: u o
<br /> B Y Y AS2-661-067353-024 10/01/202410/01/202S COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY $5,000,000
<br /> Ea accident
<br /> X ANYAUTO BODILY INJURY(Per person) G
<br /> Z
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) N
<br /> AUTOS ONLY AUTOS �p
<br /> HIREDAUTOS NON-OWNED PROPERTY DAMAGE V
<br /> ONLY AUTOS ONLY (Per accident)
<br /> lU
<br /> C UMBRELLA LIAB X OCCUR Y Y EUA2563708502 10/01/2024 10/01/2025 EACH OCCURRENCE $5,000,000 U
<br /> X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000
<br /> DED RETENTION
<br /> A WORKERS COMPENSATION AND Y WA566DO67353014 10/01/2024 10/01/2025 X I PER STATUTE I OTH-
<br /> EMPLOYERS'LIABILITY y/N ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $1,000,000
<br /> OFF ICER/MEMBER EXCLUDED? N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000—_
<br /> E Environmental Contractors and Y �PCADB50260631024 10/01/2024 10/01/2025 Aggregate/Each LOSS $2,000,000—
<br /> Prof claims Made Prof Agg SIR $600,000
<br /> SIR applies per policy ter s & condi ions Prof Each Claim SIR $200,000
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> [RE: Construction, All Operations.]
<br /> [AI: City of Santa Ana, its officers, employees, agents and representatives] are included as Additional insured with respect
<br /> to the General Liability and Automobile Liability Policies; granted a waiver of Subrogation for the General Liability,
<br /> Automobile Liability, Professional Liability and workers' Compensation Policies; and General Liability Policy evidenced herein
<br /> is Primary and Non-Contributory to other insurance available as required by written contract but limited to the operations of
<br /> the insured under the said contract. Excess Liability is Follow Form. All
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br /> EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br /> POLICY PROVISIONS.
<br /> City of Santa Ana AUTHORIZED REPRESENTATIVE
<br /> Attn: Risk Management Division
<br /> 20 Civic Center Plaza, 4th Floor oR.Nce DEVis
<br /> Santa Ana CA 92701 USA c�J-Y
<br /> u REVIEWED&APPROVID 8Y:
<br /> ,�',
<br /> A�Acevedo
<br /> Risk Management Specialist
<br /> ©1988-2015 ACORD CC
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|