INSTRUMENT CONTROL SERVICES - Laserfiche WebLink

Home Browse Search

ninitally cinninA ACCO " CERTIFICATE OF LIA L ANCE' v y �u y E(M /D /YYYY) Ill 04/27/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANEFCC&FIEF& llbft&UPONTHF :ER FICATE� LDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR Al T HE COVERAGE P =F,�>I'��f ICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE IS U' JG I RIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poli u av v5 R If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, ce ain policies may re quire an a do se a t. tate e t this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). — PRODUCER CONTACT NAME: Claribel Ga.;..d Tolman & Wiker Insurance Services, LLC NN. (805) 585-6179 FAX, (805) 585-6200 A/CO, Ext : No): 196 S. Fir Street E-MAIL ADDRESS: cn arcia tolmanandwiker.com g INSURER(S) AFFORDING COVERAGE NAIC# PO Box 1388 INSURERA: Crum & Forster Specialty Ins. Co. 44520 Ventura CA 93002-1388 INSURED INSURER B: WestAmerlcan Ins Co 44393 Instrument Control Services, INSURER C : StarNet Ins Co 40045 DBA: ICS INSURER D : 6085 King Drive #100 INSURER E : Ventura CA 93003 INSURER F: COVERAGES CERTIFICATE NUMBER. 22/23 GL/AU/XS/WC/EO 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSD WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREM SES Ea occurDrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV I NJ U RY $ 1,000,000 A Y Y EPK-137097 09/23/2021 09/23/2022 GEN' LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑X JECT ❑ LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00C X BODILY INJURY (Per person) $ ANYAUTO B OWNED SCHEDULED AUTOS ONLY AUTOS BAW(22)57612929 10/20/2021 10/20/2022 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS -MADE EFX-118920 09/23/2021 09/23/2022 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A KEY0138780 O5/01/2022 O5/01/2023 X1 STATUTE EORH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1,000,000 $ ERRORS & OMISSIONS A EPK-137097 09/23/2021 09/23/2022 Limit: 1,000,000 Deductible: 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) GL: The City of Santa Ana, its officers, officials, employees, and volunteers are Additional Insured as respects to referenced project per forms EN01110211 and EN03200211. This Insurance is Primary & Non -Contributory to any other Insurance per form EN01180211. A Waiver of Subrogation is added in favor of the Additional Insured per form EN1180211. Endorsements apply only as required by current written contract on file. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana ACORD 26 (2016/03) CA 92703 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 Co7�FI:I:��>GN1 The ACORD name and logo are registered marks of ACORD Risk ManagementDiAsian REVIEWED&�" APPROVED BY.- �_r- Risk Management Specialist