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TORRES, MARTIN (4)
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TORRES, MARTIN (4)
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Last modified
10/16/2023 10:21:18 AM
Creation date
9/13/2023 4:57:11 PM
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Contracts
Company Name
TORRES, MARTIN
Contract #
N-2022-256-01
Agency
Parks, Recreation, & Community Services
Expiration Date
6/30/2024
Destruction Year
2029
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Trac Digitally signed <br />Y by TracyJacobs <br />4U O CERTIFICATE OF LIABILITY INSURANCE Jacobs D5: 1ale B405Y1��DIZ YYY) <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 BELOW. <br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE <br />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. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />Maguire Insurance Agency, Inc. FWI <br />1 Bala Piz Ste 100 <br />Bala Cynwyd, PA 19004-1401 <br />810.817.7WO <br />NAME: <br />PHONE <br />(A/C, No, Exh: <br />FAX <br />(A/C, Ni <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Philadelphia indemnity Insurance Company <br />ifawa <br />INSURED <br />INSURER B: <br />mtorresalvarez <br />2222 S Mahawk Avo <br />" <br />INSURER C: <br />INSURER D : <br />Santa Are, CA 92704 <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION 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 INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE <br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS <br />OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />AODL <br />SUER <br />POLICY EFF <br />POLICY EXP <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />IMMIDD/YYYY) <br />(MMIDDIYYYY) <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />X <br />PHPK2324258001 <br />09/O9/2022 <br />MM912023 <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE X OCCUR <br />DAMAGE TO RENTED <br />PREMISES (Ea occurcence) <br />$100,000 <br />X <br />MED EXP (Anyone person) <br />$2.500 <br />PROFESSIONAL LIABILITY <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GEN'L <br />GENERAL AGGREGATE <br />$3,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY El PROJECT ❑LOC <br />X <br />PRODUCTS - COMP/OP AGO <br />$3,000,000 <br />OTHER <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILY INJURY (Per parson) <br />$ <br />ANY AUTO <br />OWNED AUTOS SCHEDULED AUTOS <br />ONLY <br />BODILY INJURY Penal <br />$ <br />HIREDAUTOS <br />PROPERTY DAMAGE <br />HNON,DWINED <br />ONLY AUTOSONLY <br />(Per accident) <br />Is <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED <br />RETENTION$ <br />PER <br />OTHER <br />AND EMPS YERSILIATION <br />AND ILIT YIN <br />STATUTE <br />ROPRIEERRIPART ERV <br />ARTNEDEXECUTIVE <br />ANYICERIM <br />NIA <br />MBER <br />OFFICERIMEMBER EXCLUDED? <br />E. L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory in NH) <br />f yes, describe under <br />E,L. DISEASE ' POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS be. <br />A <br />X SEXUAL ABUSEAND MOLESTATION LIABILITY <br />PAPK2324258,001 <br />09/09/2022 <br />09/09/2023 <br />EACH OCCURENCE <br />$100,000 <br />AGGREGATE <br />$300000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />It is understood and agreed that the following entity's added as an additional insured but only with respects) to the operations of the named insured except that liability resulting from the addifimul Insured'. ..Is <br />negligence. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, Parks, Recreation and Community Services <br />20ACanter Piz <br />SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />SantantaAna, CA 92701-4058 <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH <br />THE POLICY PROVISIONS. <br />9 <br />I <br />9E t � 6n <br />+)4-� r REVIEWED^&APPRotVED BY: <br />eiidi <br />t n Risk Maa emen <br />© 1988-2015 ACORD C( `� Analyst <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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