Laserfiche WebLink
AC-ORD.CERTIFICATt OF LIABILITY INSURAN.,E <br />DATE <br />03/(09/2 al <br />PRODUCER (714)905-1923 FAX (714)905-1910 <br />Hayward Tilton & Rol app Ins. Assoc., Inc. <br />License #0614365 <br />P.O. Box 25529 <br />Anaheim, CA 92825-5529 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURED Hernandez Cart Service, Inc. d_-00+_I�. <br />DBA: — =0.2— 1t O <br />/t 1808 Lincoln Blvd. I O <br />/S} <br />Venice, CA 90291 — d0O 3^ i <br />INSURERA: Nautilus Insurance Company <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />NSURER E: <br />rnVFDArrc <br />V THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN( <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />:NSR <br />OD' <br />rypE OF INSURANCE <br />POLICY NUMBER <br />PCUCY EFFECTIVE <br />FOLICYEXFIRATIGN <br />LIMITS <br />GENERAL LIABILITY <br />NC311366 <br />03/04/2004 <br />03/04/2005 <br />EACHOCCURRENCE <br />$ 1,000,000 <br />X COMMERCIALGENERAL LIABILITY <br />DAMAGE TO RENTED <br />$ 50,000 <br />CLAIMS MADE 1XI OCCUR <br />MED EXP (Any one person) <br />$ 1,000 <br />A <br />X <br />PERSONAL SADVINJURY <br />E 1,000,000 <br />GENERAL AGGREGATE <br />$ 1,000,000 <br />GEN-L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />$ Included <br />POLICYPRO. LOC <br />ECT El <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />E <br />ANY AUTO <br />IEa accident) <br />BODILY INJURY <br />S <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />(Per person) <br />BODILY INJURY <br />E <br />HIRED AUTOS <br />NON OWNED AUTOS <br />(Per accident) <br />PROPERTY DAMAGE <br />$ <br />(Peraconcent) <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCIDENT <br />E <br />OTHERTHAN EAACC <br />E <br />ANY AUTO <br />S <br />AUTO ONLY: AGO <br />EXCESSIUMBRELLA LIABILITY <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />E <br />OCCUR CLAIMS MADE <br />E <br />DEDUCTIBLE <br />/ <br />$ <br />RETENTION E <br />GV <br />..�' <br />WORKERS COMPENSATION AND <br />WC STATU- OTq- <br />TJ=�-IT�`— <br />EMPLOYERS' LIABILITY <br />E.L EACH ACCIDENT <br />3 <br />ANY PROPRIETOR/PARTNEWEXECUTIVE <br />E.L. DISEASE EA EMPLOYE <br />E <br />OFFIOER/MEMSER EXCLUDED? <br />yes. CB Unger <br />S <br />E.L. DISEASE-POLICV LIMB <br />3 <br />PROVISIONS <br />P <br />SPECIAL PROVISIONS below <br />OTHER <br />DESCRIPTION OF OPEPATIONS LOCATION VEHIyLES I EXPLOSION ADDED BY ENDORSEMENT IS ECIAL PROVISIONS <br />en days notice ot� canceSatTon given for non-payment ote premium. <br />The City of Santa Ana its officers, employees, agents, volunteers & representatives are <br />additional insureds as respects General Liability per endt S114 (04.97) <br />The City of Santa Ana <br />Attn: Dave Urbin M85 <br />220 S. Daisy Avenue, Bldg A <br />Santa Ana, CA 92703 <br />ACORn7snnnvnR) FAX: (714)647 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL #XTYX%y&*X MAIL <br />DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT <br />i(IXrYPXX�%F1S%A;X;txYi3�rX)f #X XXaXX%#7S�'rX>vd§YI%X3�4�4X4kXyrX XX'. <br />AUTHORIZED REPRESENTATIVE <br />Stephen Moriyama/MTA Stephen Moriy4rnca <br />nArnon rnDonoATlnM 1CRF <br />with FinePrint 2000 - purchase at http://www.fi <br />