|
AcckRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
<br /> 441, ..------ 9/19/2024 12/14/2023
<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 sucl en emenk
<br /> PRODUCER Lockton Companies N .M?^
<br /> 444 W.47th Street,Suite 9 P. 0'JE FAX
<br /> I e % E y A nV e (A/C,No):
<br /> Kansas City MO 64112-1 o RE
<br /> (816)960-9000
<br /> kC8SL1G10CICIOn.COm INSURE )AFFORDING COVERAGE NAIL#
<br /> : SUIk ,y,/�� Q1�A, t ,i'•,, : —asualty Corporation_ 15105
<br /> INSURED UNITED SITE SERVICES F CALIFORNIA,INC. .NSURER 'N , 'p c . '. rance Company 37885
<br /> 1507679118 roa�x,,,.I anc. 19489
<br /> E TBORO G ROAD, TE � RE ce o �.�y
<br /> WESTBOROUGH MA 0 M . - � ] tie . 19402
<br /> yr
<br /> RERE:///���
<br /> _ INSURER .� .•35.47• RQZQQ)
<br /> COVERAGES CERTIFICATE NUMBER: 8427412 • R�ElV SIOIVVI-VVDMBER: XXXXXXX
<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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP
<br /> LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)_ LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY Y Y GL4057787 12/31/2023 12/31/2024 EACH OCCURRENCE $ 2,000,000
<br /> DAMAGE TO RENTED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br /> X POLICY JNT LOC PRODUCTS-COMP/OP AGG $ 4,000,000
<br /> OTHER: $
<br /> A AUTOMOBILE LIABILITY N N CA6675838 12/31/2023 12/31/2024 COMBINED SINGLE LIMIT $
<br /> (Ea accident) 3,000,000
<br /> X ANY AUTO BODILY INJURY(Per person) $ XXXXX
<br /> OWNED SCHEDULED BODILY INJURY(Per accident) $ XXXXXXX
<br /> AUTOS ONLY _ AUTOS
<br /> HIRED NON-OWNED PROPERTY DAMAGE
<br /> AUTOS ONLY AUTOS ONLY (Per accident) $ XXXXXXX
<br /> $ XXXXXXX
<br /> B X UMBRELLA LIAR X OCCUR N N US00076933LI23A 12/31/2023 12/31/2024 EACH OCCURRENCE $ 10,000,000
<br /> D EXCESS LIAB CLAIMS-MADE BE018993878 12/31/2023 12/31/2024 AGGREGATE $ 10,000,000
<br /> DED RETENTION$ $ XXXXXXX
<br /> A WORKERS COMPENSATION N X PER STATUTE ER
<br /> H AND EMPLOYERS'LIABILITY Y/N LDS4047370 12/31/2023 12/31/2024
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
<br /> OFFICER/MEMBER EXCLUDED? N N/A
<br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
<br /> If yes,describe under
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
<br /> C ENVIRON.SITE LIAB& N N' 0311-5276 9/19/2021 9/19/2024 $3,000,000 EACH INCIDENT;
<br /> CONTRACTORS $6,000,000 AGGREGATE
<br /> POLLUTION LIAB
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> THE CITY OF SANTA ANA,ITS OFFICERS,OFFICIALS,EMPLOYEES,AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED,AS RESPECTS TO
<br /> LIABILITY ARISING OUT OF THE ACTIVITIES PERFORMED BY OR ON BEHALF OF TI-IE NAMED INSURED,WHERE COVERAGE SHALL BE PRIMARY AND
<br /> NON-CONTRIBUTORY TO ANY POLICY HELD BY THE ADDITIONAL INSURED,AND INCLUDES A WAIVER OF SUBROGATION WHERE ALLOWED BY
<br /> STATE LAW AS REQUIRED BY WRITTEN AGREEMENT,AND SUBJECT TO POLICY TERMS,CONDITIONS,AND EXCLUSIONS.
<br /> CERTIFICATE HOLDER CANCELLATION See Attachments
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I
<br /> 18427412 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PRC\
<br /> RISK MANAGEMENT DNISION
<br /> a ort.t,s, Risk ManagemeltDivis(an
<br /> AUTHORIZED REPRESENTAT 'J 3 REVI
<br /> 20 CIVIC CENTER PLAZA ' APPROVEDEWED& BY:
<br /> SANTA ANA CA 92702 `;1�� r, >ticeuda
<br /> I 7 Al Lam°.-^� Risk Management Specialist
<br /> ©1988' 015 ACORD /
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|