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Last modified
10/10/2024 4:09:10 PM
Creation date
10/10/2024 4:09:10 PM
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Contracts
Company Name
GOLDEN WEST FENCE
Contract #
P 22-1418
Agency
Public Works
Insurance Exp Date
12/13/2024
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A4C"JZor CERTIFICATE OF LIABILITY INSURANCE <br />DATE/ sno24YY) <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 <br />Orr & Associates Insurance Services <br />28780 Single Oak Or <br />Ste 255 <br />Temecula CA 92590 <br />CONTACT <br />NAME: Certificates <br />PNONE . 951-506-5859 Fa/c No:800-474-3003 <br />pDa E. certs orrandassociates.com <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Associated Industries Ins. Co. <br />23140 <br />License#, OE63493 <br />INSURED GOLDWES415 <br />Golden West Fence <br />I e <br />20260 <br />evedo <br />20741 Hansen Ave Angie Aeeved o <br />Nuevo CA 92567 <br />S RER 0 e nsu ante man <br />41297 <br />q p <br />IA 4; r r <br />15563 <br />INSURER E: Ohio Casualty Insurance Co. <br />24074 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER:244645067 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 <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICYEFF <br />MMAID/YVYY <br />MPOLICYEXP <br />M/DD <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FX] OCCUR <br />V <br />V <br />AES124159300 <br />12113/2023 <br />12/13/2024 <br />EACH OCCURRENCE <br />$1,000,000 <br />DAMAGE TORENTED <br />PREMISES Eaoccurrance <br />$100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GEHL <br />AGGREGATE LIMIT APPLIES PER: <br />POLICYEX] JET171LOG <br />GENERALAGGREGATE <br />$2,000,000 <br />PRODUCTS-COMP/OP AGOE000000 <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />50006334901 <br />8/13/2024 <br />2/13/2025 <br />Ee BINaccE tSINGLE LIMIT <br />BODILY INJURY(Par person) <br />ANY AUTO <br />OWNED X SCHEDULED <br />ONLY AUTOS <br />BODILY INJURY Per accitlenlAUTOS <br />( )X <br />HIRED X NON -OWNED <br />ONLY AUTOS ONLY <br />PROPERTY DAMAGEAUTOS <br />Peraccident <br />c <br />UMBRELLA LIAB <br />X <br />OCCUR <br />XLS1227140 <br />6/18/2024 <br />12/13/2024 <br />EACH OCCURRENCE <br />$2.000,000 <br />X <br />AGGREGATE <br />$2,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED I I RETENTION$ <br />$ <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANYPROPRIETOWPARTNEWEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />Y <br />CWCO2779500 <br />1/12/2024 <br />1/12/2025 <br />X ISTATUTE ERH <br />E.L EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE <br />$1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />E <br />Specific Job <br />BM067931348 <br />6/24/2024 <br />6/24/2025 <br />Installation Floater <br />40,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) <br />Certificate is subject to policy limits, conditions and exclusions. <br />City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are named as additional insured as per the attached endorsement <br />forms. <br />RE: Project No. 22-1418 Stormwater Channel Fencing Upgrades Ph III. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City Of Santa Ana <br />Public Works Agency I Construction Services <br />THE EXPIRATION DATE THEREOF. <br />ACCORDANCE WITH THE POLICY PRC <br />NOTICE WILL BE DEUVERFD IN <br />Risk Management D <br />
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