|
Client#: 1261188 305CDCEINC
<br />DATE (MM/DD/YYYY)
<br />ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE 1 7/09/2024
<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 any rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER CONTACT IAa C.antora •
<br />NAME:
<br />McGriff Insurance Serv' s LLC PHONE 9 9- 2 F k7l 1
<br />A/C, No, lxt,�: ( C,
<br />130 Theory Ste 200 E-MAIL
<br />nayra.ca ran mcgrl om
<br />Irvine, CA 92617 I
<br />INSUR (S) AFFORDING COVERA NAI #
<br />714 941-2800
<br />INSURED
<br />CDCE Inc
<br />22641 Old Ca I Road
<br />Yorba Linda,x 928$
<br />(.K•11TA 4:7_TO *I
<br />INSURER C tl I C a m a
<br />INSURE! 3: 'on In al ra Insunce pany
<br />INSUR .t C : Va ' Forge Insurance m
<br />EaRD.
<br />05 8
<br />L, .
<br />_::�
<br />D�-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEL'jW ',AVE BEEN ISSUE TO UR D• ED BOVE R HE WINAPERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONE IT' jN OF ANY CONTRACTOR 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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X
<br />X
<br />4013661900
<br />3/09/2024
<br />0310912025
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE L* OCCUR
<br />PREMISES (ERENTED
<br />rrrence)$1,000,000
<br />MED EXP (Any one person)
<br />$15,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICYFx] JECOT LOC
<br />PRODUCTS-COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />6057616617
<br />3/09/2024
<br />03/09/202
<br />MBINED
<br />(CEO, cidentSINGLE LIMIT
<br />ac
<br />1e e OOO 000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />4013661914
<br />3/09/2024
<br />03/0912025
<br />EACH OCCURRENCE
<br />$5 00O 000
<br />AGGREGATE
<br />$5 00O 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I X RETENTION $1 O 000
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N / A
<br />X
<br />WC416477777
<br />06/08/2024
<br />06/08/2025
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: Proof of coverage.
<br />Certificate holder is amended to read as: City of Santa Ana, its City Council, its officers, officials,
<br />employees, agents, and volunteers
<br />Certificate holder is included as additional insured as respects general and auto liability as required by
<br />written contract.
<br />(See Attached Descriptions)
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />y THE EXPIRATION DATE THEREOF
<br />20 Civic Center Plaza M-97 ACCORDANCE WITH THE POLICY RAManagmumtDMslcrn
<br />Santa Ana, CA 92701 1 s
<br />AUTHORIZED REVIEWED & APPROVED BY:
<br />REPRESENTATIVE
<br />Risk Management Specialist
<br />© 1988-2015 ACOR
<br />ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S34863129/M34551418 2RG
<br />
|