Laserfiche WebLink
DATE(MMIDD/YYYY) <br /> ALt7C- FtiOr CERTIFICATE OF LIABILITY INSURANCE 05/20/2024 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br /> THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE <br /> POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), <br /> AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, <br /> subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not <br /> confer rights to the certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> HUB INTL MOUNTAIN STATES LTD/PHS NAME: <br /> 41451261 PHONE (866)467-8730 FAX <br /> The Hartford Business Service Center (Arc,No,at): (AJC,No): <br /> 3600 Wiseman Blvd E-MAIL Digitally i g n e d <br /> San Antonio,TX 78251 � ADDRESS: <br /> V in \FOy}pING COVERAGE NAIC1t <br /> INSURED �RER A: Sel ine I n n^' 11000 <br /> MARTHA VAN ROOIJEN DBA MVR C NSU In URER B: <br /> PO BOX236 Acevedo <br /> CALIMESA CA 92320-0236 INSURER C: <br /> INSURER D: <br /> ai6R.41 - • 2024.07. 11 <br /> • <br /> COVERAGES <br /> IS CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW.1AV'.BEEN ISSUED TiviiIARR NA 1 4BCv <br /> TO T ICY PERIOD <br /> INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDIT,ON'JF 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 <br /> TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br /> LTR INSR WVD IMMIDD/YYYY) ,LMMIDDIYYYYI <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED $1,000,000 <br /> PREMISES(Ea occurrence) <br /> x General Liability MED EXP(My one person) $10,000 <br /> A X X 41 SBA AC2507 05/19/2024 05/19/2025 PERSONAL&ADV INJURY $2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 <br /> POLICY El PRO- 17 <br /> LOC PRODUCTS-COMP/OP AGG $4,000,000 <br /> JECT <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $2,000,000 <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) <br /> A ALL OWNED SCHEDULED X 41 SBA AC2507 05/19/2024 05/19/2025 BODILY INJURY(Per accident) <br /> AUTOS AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE <br /> X AUTOS X AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE <br /> EXCESS LIAB CLAIMS- AGGREGATE <br /> MADE <br /> DED RETENTION$ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY STATUTE ER <br /> ANY YIN E.L.EACH ACCIDENT <br /> PROPRIETORIPARTNER/EXECUTIVE - <br /> OFFICER/MEMBER EXCLUDED? Nl A E.L.DISEASE-EA EMPLOYEE <br /> (Mandatory In NH) <br /> If yes,describe under E.L.DISEASE-POLICY LIMIT <br /> DESCRIPTION OF OPERATIONS below <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> Those usual to the Insured's Operations. <br /> CERTIFICATE HOLDER CANCELLATION <br /> City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> 20 CIVIC CENTER PLZ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED <br /> SANTA ANA CA 92702 IN ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> U ic6Q'? (lad RtlA1B t�,e RiskManagmnmstDivislon <br /> o �. REVIEWED&APPROVED BY: <br /> ©1988-2015 ACORD COI' ` : <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD jam,, A <br /> �� Risk Management Specialist <br />