Laserfiche WebLink
1 1 rKvinza <br />A� CERTIFICATE OF LIABILITY INSURANCE LY <br />P <br />DATW21fD021 <br />4127/2021 <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. <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 doos nok confer rights to the certificate holder in lieu of such endorsements . <br />PRODUCER 877.242-9600 <br />centr93EastMainStre Agency, <br />03 East Main Y 117 . <br />Smithtown, NY 11707 <br />George Oavarls <br />RRAYCT Central Insurance Agency, Inc <br />PIVOT 877.242.9600 877-243.8995 <br />c No, Ex1: c Nal: <br />INSURERS)AFFORDING COVERAGE <br />NAIO If <br />I ! Employers Assurance Company <br />25402 <br />Ne RE <br />o von merica Inc. <br />0r hoHgg <br />9 3Ra svrortfi, CAINSURERD: <br />INSURER J$: <br />INsuRELc,InfinitySelect Insurance Company <br />20200 <br />INSURER E: <br />_ <br />NeURER F: <br />CERTIFICATE NUMBER- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INBR <br />rypE OF INSURANCE <br />DDL <br />UBR <br />POLICY NUMBER <br />POLICY EFF <br />POUCYEXP <br />LIMITS <br />COMMERCIAL OFNERAL LIABILITY <br />CLAIMS -MADE ❑ OCCUR <br />EACH OCCURRENCE <br />$ <br />GETQRENTED <br />E <br />MED E* (Any one ,e son <br />ONALBADVINJ <br />$ <br />LIES <br />EN1AGGREGATE LIMIT APPLIES PER: <br />�I PRO- An <br />POLI JEGT LOC <br />RAL AGGREGATE <br />PRODUCTS - COMING? 00 <br />8 <br />OTHER: <br />C <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AU O <br />NEHDUL <br />AUED <br />WE%ONLY SyyM <br />XX <br />604610110722001 <br />10/06/2020 <br />10/OB(2021 <br />COMBINED SINGLE LIMIT <br />Fee <br />1,996 BBB <br />BODILY INJURY IV on <br />$ <br />BODLY INJURY Per mcldent <br />$ <br />Pg.ER;YDAMAGE <br />$ <br />UMBRELLA LMB <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAS <br />CLAIMS -MADE <br />AOGREQATE <br />DEO RETENTION$ <br />A <br />WW <br />AN, EMPLOYEMRS' COMPENSATION <br />YINEIG25620B4-02 <br />AQQNppYPRFFOPRIET99O¢¢RRRIPARTTNERIGXECUTIVE <br />(mandataryln NH) EXCLU DED'i Y <br />II eCR[dbe UndOPERATIO Sbea <br />WA <br />X <br />1110612020 <br />71lOG/2021 <br />X STATUTE OTH- <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E. L. DISEASE -EMPLOYE <br />1,000,00B <br />E.I DISEASE -PO YLIMIT <br />1,000,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES tACORD 101, Addtlionel Remarks Schedule, maybe attoohed If more space Is mquhed) <br />The City of Santa Ana, its officers, employees, agents, and representatives are named as <br />additional insured under the Commercial Auto Liability On this policy pursuant to written <br />contract, agreement, or memorandum Of understanding, Waiver of subrogation applies to the <br />Workers Compensation par the attached endorsement. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 Civic Center Plaza <br />Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE <br />MAMWMentDir(filan <br />_-F °. i REVIEViID � &gPPROVBY% <br />ACORD 25 (2010103) a 1988-2015 ACORD C 'S'; II F4,LI ow P, VAwd <br />The ACORD name and logo are registered marks of ACORD 'I� MIX Manugemrnt Analyst <br />