Laserfiche WebLink
MDGASSO-01 <br />AMARIN <br />,a►�ofzo' CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDOYYYY) <br />nnzort <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 endorsements . <br />PRODUCER <br />CONEACT Aaron Marin <br />AmoreM, Rosemann, & Associates <br />3110 E. Guasti Road <br />Suite 500 <br />PHONE FAX <br />(A/C, No, EXt): (909) 660-3903 (A/C, No); <br />A%ffiaESS: aaronm@arainsurance.com <br />Ontario, CA 91761 _ - <br />INSURERS AFFORDING COVERAGE <br />NAICIf <br />INSURER A: State Compensation Insurance Fund of California <br />35076 <br />INSURED <br />INSURER B : <br />INSURER C : <br />. Mdg Associates, Inc. <br />INSURER D : <br />10722 Arrow Route Ste 822 <br />Rancho Cucamonga, CA 91730 <br />INSURER E <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- <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 CONTRACTOROTHER DOCUMENT WITH RESPECTTO 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 />ADDLSUBR <br />INSD <br />Wye <br />POLICYNUMBER <br />POLICY EFF <br />p <br />POLICY EXP <br />pffAGGRE�TE <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />ENCE <br />$ <br />ENTED <br />$ <br />one arson <br />$ <br />DV INJURY <br />$ <br />GEWL AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ jEPT LOG <br />OTHER: <br />REGATE <br />$ <br />OMP/OP AGG <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AU��T�pOS <br />AUTOS ONLY AUr03 ONLY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Per arson <br />$ <br />BODILY INJURY Per accident <br />$ <br />PeOaccdi DAMAGE <br />$ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />DED RETENTION$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />ppFFICEILMEMBER EXCLUDEDT �Y <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />X <br />1980750-21 <br />711/2021 <br />71112022 <br />)( PER OTH- <br />T ER <br />E.L. EACH ACCIDENT <br />1r000rQ00 <br />E.L DISEASE - EA EMPLOYE <br />1,DOD,9DD <br />E.L DISEASE - POLICY LIMIT <br />1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />Proof of coverage. Waiver of subrogation applies. <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA, 4th Floor <br />SANA ANA, CA 92702 <br />ACORD 25 (2016103) <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 />7 <br />©1988-2015 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />REVIEWED & APPROVED BY: <br />[ <br />r 4MµY R. V g <br />Risk Management Analyst <br />