AJ PORTABLES, INC. - Laserfiche WebLink

Home Browse Search

Aa CERTIFICATE OF LIABILITY INSURANCE ATE D06/08/2021�) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED 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 terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER State Farm Insurance: Wendy Truong CONTACT NAME: MARITZATINAJERO 9011 Garvey Ave. Suite B 1717177-11 Rosemead, CA 91770 "ONE A/c,No Ext: 626 382-1490 a No: 626 382-1496 E-MAIL ADDRESS: Maritza.Tinajero.uzlm@statefarm.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: State Farm Mutual Automobile Insurance Com an 25178 M INSURED Jennifer Cammack INSURERB: INSURERC: DBAAJ Portable Restroom INSURERD: 31 Brassie Ln Coto De Caza , CA 92679 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY ❑ ❑ EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) $ CLAIMS-MADE1:1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC JECT $ A AUTOMOBILE LIABILITY FYI El COMBINED SINGLE LIMIT (Eaaccident $ 1,000,000 ANY AUTO 475-9570-A09-75A 07/09/2020 07/09/2021 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL AUTOS OWNED )( AUTOSULED NON -OWNED HIRED AUTOS AUTOS FX PROPERTY DAMAGE Peraccident $ X $ Comp- 100 Col..-100 UMBRELLA LIAB OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICE/MEMBER EXCLUDED? ❑ N / A ❑ WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) E.L. DISEASE -POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A UMBI: $250,000/500,000 UMPD: $3,500 � � 475-9570-A09-75A 0710912020 07109/2021 MED: 5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) VEHICLE(S:) 2007 ISUZU NPR FLATBED VIN: JALC4B16577000723 2017 DODGE 5500 TANK VIN:3C7WRMDL8HG760781 2019 ISUZU NPR -HD- TANK TRK VIN:54DC4W1 B5KS800204 2006 GMV STAKE TRUCK VIN: J8DB4B16667019792 City Of Santa Ana, officers, agents, employees, and volunteers are named as additionally insured on this policy pursuant to written contract, agreement, or memorandum of understanding. Such insurance as is afforded by this policy shall be primary, and any insurance carried by City Shall be excess and noncontributory. Agreement Number (A-2020-131-07) CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana, Ca 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE RiskMudgemenf Ihvieinn ��/JJ -. ReoEwm & APPROVED B'I: MARITZATINAJERO ;D&W rs © 1988-2010 AC D CC Risk IA—gemenroeri-lAide V N O ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD -- -