|
AC RO®® CERTIFICATE OF LIABILITY INSURANCE GATE(MMIDDIYVYV)
<br /> 4......--- 11/13/2023
<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 such endorsement(s).
<br /> PRODUCER CONTACT
<br /> NAME: Debbie Stocker
<br /> Arthur J. Gallagher Risk Management Services, LLC PHONE FAX
<br /> 4201 Westown Parkway C No Exit;515-309-6215 (A/C,No):
<br /> Suite 120 ADDRESS: debble stocker@ajg.com
<br /> West Des Moines IA 50266 INSURER(8)AFFORDING COVERAGE NAIC#
<br /> INSURER A:EMC Insurance Companies 21415
<br /> INSURED INSURERS:Employers Mutual Casualty Company 21415
<br /> Elliott Auto Supply Co., Inc dba Factory Motor Parts 1380 INSURER c:Navigators Insurance Company 42307
<br /> Corporate Center Curve Suite 200 INSURERD:
<br /> Eagan MN 55121-1200 INSURERE:
<br /> INSURER F:
<br /> COVERAGES CERTIFICATE NUMBER:1424680087 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
<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 ADDLSUBR POLICYEFF POLICY EXP
<br /> R TYPE OF INSURANCE W LIMITS
<br /> INSO VD POLICY NUMBER IMM/DD!YYYY) IMM/DD/YVYY)
<br /> A X COMMERCIAL GENERAL LIABILITY V Y 2D39543 11/15/2023 11/15/2024 EACH OCCURRENCE $2,000,000
<br /> DAMAGE TO RENED
<br /> CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $2,000,000
<br /> X 100,000 MED EXP(Any one person) $5,000
<br /> PERSONAL SADV INJURY $2,000,000
<br /> GENII_AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000
<br /> POLICY PRO-
<br /> JECT X LOC PRODUCTS-COMP/OP AGG $3,000,000
<br /> OTHER: Property Damange $2,000,000
<br /> B AUTOMOBILE LIABILITY Y 2139543 11/15/2023 11/15/2024 COMBINED SINGLE LIMIT $2,000,000
<br /> A 2E39543 11/15/2023 11/15/2024 (Ea accident)
<br /> B X ANY AUTO 2G39543 11/15/2023 11/15/2024 BODILY INJURY(Per person) $
<br /> B OWNED SCHEDULED 2T39543 11/15/2023 11/15/2024
<br /> B AUTOS ONLY X AUTOS 2Z39543 11/15/2023 11/15/2024 BODILY INJURY(Per accident) $
<br /> x HIRED X NON-OWNED PROPERTY DAMAGE $
<br /> AUTOS ONLY AUTOS ONLY (Per accident)
<br /> Ded Comp/Collision $1,000
<br /> B X UMBRELLALIAB X OCCUR 2J39543 11/15/2023 11/15/2024 EACH OCCURRENCE $3,000,000
<br /> O NY23EXRZOFH7JIV 11/15/2023 11/15/2024
<br /> X EXCESSLIAB CLAIMS-MADE AGGREGATE $3,000,000
<br /> DED X RETENTION$In non Excess Liability $10,000,000
<br /> B WORKERS COMPENSATION 2N39543 11/15/2023 11/15/2024 X STATUTE EOTH Statutory
<br /> B AND EMPLOYERS'LIABILITY Y/N 2P39543 11/15/2023 11/15/2024
<br /> B ANYPROPRIETOR/PARTNER/EXECUTIVE 2M39543 11/15/2023 11/15/2024 E.L.EACH ACCIDENT $1,000,000
<br /> B IM OFFICEREMBEREXCLUDED? N N/A 2L39543 11/15/2023 11/15/2024
<br /> (Mandatory In NH) 2R39543 11/15/2023 11/15/2024 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 /> A GARAGE LIABILITY 2E39543 11/15/2023 11/15/2024 Auto Only- Ea Ace $500,00D
<br /> DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Elliott Auto Supply Co., Inc.inclusive of Factory Motor Parts and Splash Products
<br /> RE: Project#A-2019-085 The City of Santa Ana,20 Civic Center Plaza,Santa Ana,California 92702;its officers,employees,agents and volunteers are
<br /> included as Additional Insured under the General Liability policy per form CG71S4(10/13)and auto liability policy per form CA7270(03/07)as per written
<br /> contract requirement pursuant to and subject to the policy's terms,definitions,conditions,and exclusion.The insurance provided in the General Liability policy
<br /> is Primary and Non-Contributory and any other insurance shall be excess only,and not contributing per form CG7184(10/13)as per written contract
<br /> requirement pursuant to and subject to the policy's terms,definitions,conditions,and exclusion.Waiver of Subrogation applies to the Additional insureds as
<br /> respects to the General Liability per form CG7555(4/13),pursuant to and subject to the policy's terms when required in a written contract or agreement per
<br /> form
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Risk Management Division
<br /> 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE
<br /> Santa Ana CA 92702 T-il 314�p«r°`Cr
<br /> I `t/t !
<br /> ©1988-2015 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|