|
/_sssN /� ,,� @RAFPRO.O', Digital
<br />'`�`�R" CERTIFICATE OF LIABILITYAMFQJI& by'f'I r`-
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEI €1B.VIE1 DER. THIS
<br />BELOW.CERTIFICATE
<br />CERTIFICATEFOFt INSURANCE DOES NATIVELY OR IOTLY AMEND, CO STITUTEXAECONTWYy1T E J{(F� Cp R �F�i�E}�B ;,IFf€ (�LI IES.
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ��� �"�B`�MI`ERVN {JEr rLR
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONr,L'ASURED p 9i I Br
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may rr.luire an endorsement. A statement on
<br />PRODUCER ....... N.......
<br />" ' ry Haneue verges
<br />-IUB International Insurance Services Inc. (A/G No, Ezg: (916 770-2918 FAX 951 231-2572
<br />. O. BOX 4047 ) F C No):( )
<br />:oncord. CA 94524-0047 :hM .«<. cal.cpu cDhubinternational.com
<br />INSURED
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />COVERAGES CERTIFICATE NUMBER: RFVICInN NIIMRPO:
<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.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MPOLICCY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PACEP4245050-03
<br />2/17/2022
<br />2f17f2023
<br />EACHOCCURRENCE
<br />$ 1,000.000
<br />DAMAGE TO RENTED
<br />acccurrenc
<br />100000
<br />MED EXP (Any one erson
<br />5,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY[ X1ma1:1 LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />B
<br />_AUTOMOBILE LIABILITY
<br />IEO aBI eED SINGLE LIMIT
<br />$ 2,000A(M
<br />BODILY INJURY Per erson
<br />$
<br />X ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUU�TNpOppSyy
<br />X
<br />X
<br />AS6-Z91.466837-012
<br />111/2022
<br />1/1/2023
<br />BODILY INJURY Per accident
<br />$
<br />PerOaca `ZDAMAGE
<br />$
<br />E
<br />AUTOS ONLY AUTOS ONLOV
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />DED I I RETENTION$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />ppppFICERIMEMBER EXCLUDED? Y
<br />(Manthaton, in NH)
<br />Ryes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />X
<br />WC2-Z91-466837-022
<br />1H/2022
<br />lIV2023
<br />X PER OTH-
<br />E ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />E.L. DISEASE- POLICY LIMIT
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />Re: Service Contract
<br />City of Santa Ana, its officers, agents, employees and representatives, as additional insured as respects to General Liability per attached forms
<br />EPACE101-0814 & EPACE100-0814, and coverage applies on a Primary & Non -Contributory basis per EPACE107-0714; and additional insured in respects to
<br />Auto Liability per AC8467 0415. Waiver of Subrogation applies to Auto Liability per AC8407 0713, pg. 10 of 11, XXIII, and Workers Compensation per
<br />WC040306 (4-84). As required by written contract.
<br />30-Day Notice of Cancellation for General Liability will be provided in accordance with attached form EPACE106-0714.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof 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, 4th Floor
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />,I ,,.=^r,s Risk agent kMarvltDhislan
<br />_ mA�' :`cw REVIEWED&APPROV BY:
<br />ACORD 25 (2016/03) ©1988.2015 ACORD I .. tl4V Ae444
<br />The ACORD name and logo are registered marks of ACORD - Risk Management Smoahst
<br />
|