|
OP ID: SN
<br />1ACVRLJ' DATE (MMMNYYY)
<br />,,. CERTIFICATE OF LIABILITY INSURANCE 1 04130112
<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 />I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />--RESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />RTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsemen s .
<br />NTACT
<br />PRODUCER 5562-424-1621 NAME:
<br />The Dougherty Company, Inc. PHONE ; FAx _
<br />P.O. Bois 727 562 d90-0432 IA& No 90) ... ..... ..__ lAtc Nox.... E MAIL
<br />_..
<br />Long Beach, CA 90807 A DRESS
<br />Richard Lindgren aRODiftR _ . .... ....
<br />c srpME,:IU At PARAG 3
<br />INSURERS) AFFORDING COVERAGE NAIL 0
<br />INSURED Paragon Partners Ltd. INSURER A: Hartford Insurance Company 29424
<br />5762 Bolsa Avenue, Suite 201 INSURER
<br />Huntington Beach, CA 92649 --- _
<br />INSURER C :
<br />INSURER D
<br />INSURER £
<br />i INSURER F
<br />rnVFRAr3FC CFRTIFICATF NLIMRFR! RFVISIdN NLIMRFR-
<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
<br />WHICH THIS
<br />1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_.
<br />..._ _ ....... _
<br />MiDD1Y FF,._MMIDWYYYP
<br />LTR TYPE OF INSURANCE POLICYNUMBER
<br />LIMITS
<br />GENERAL LU1BILirY
<br />I EACH OCCURRENCE S
<br />1,000,00
<br />A X i COMMERCIAL X T2UUNUR1666
<br />_
<br />05/01112 05/01/13 ' 6 i6R1RTEC
<br />FREMISEStEaocwrrencs/_ '.g
<br />30...
<br />CLAIMS -MADE ; X ;OCCUR
<br />ME'D EXP {Any one persatl} S
<br />10,00
<br />X
<br />PERSONAL. & ASV INJURY $
<br />..........
<br />1,000,00
<br />...; ............ .....................
<br />GENERAAGGREGATE ...._...._._.2,000,00
<br />EN'L AGGREGATE LIMIT APPL :ES PER
<br />PRODUCTS COMP1OP AGG ! I
<br />2,000,00
<br />_ .-
<br />n POLICY LOG
<br />�.JTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT , $
<br />1,000,00
<br />A ANY AUTO 72UUNUR1666
<br />05/01112 05101/13 - {Ea as c ....
<br />i
<br />I
<br />BODILY INJURY;Per parson) S
<br />ALL OWNED AUTOS
<br />" BODILY MUORY(Per ar.,ci&M1 S _
<br />...... _-.
<br />SCHEDULED AUTOS
<br />- PROPERTY DAMAGE
<br />X ;HIRED AUTOS
<br />roar acradeni) S
<br />-'............
<br />_ _..._....__
<br />_......
<br />i. X.,! NOWOWNEDAUTOS
<br />X INSD OWNS -0- AUTOS
<br />- --
<br />s
<br />X I UMBRELLA LIAe ; X ;OCCUR
<br />i EACH OCCURRENCE 3
<br />10,000,00
<br />EXCESS LU46 CMADE
<br />......A 72RHUUSO426
<br />AGGREGATE ..
<br />05/01/12 05/01/13
<br />10,000,00
<br />i DEDUCTIBLE
<br />-
<br />S
<br />-
<br />RETENTIW4 S 10,000
<br />$
<br />RICERS COMPENSATION
<br />WC STATU : OY H
<br />X T.'ORY. Lw � S_. LP
<br />AND EMPLOYERS' LIABILITY
<br />Y1`
<br />- 1. .
<br />. _
<br />A FRET . ";VE i NA'72WENG6914
<br />01/01/12 01/01/13 c L cAiHA4CIDENT S
<br />1,000,00
<br />: iNYf RPARrN EDxE
<br />IMUMalwy in NH) _
<br />E L DISEASE . EA EMPL OYCEi S
<br />1,000,00
<br />!1 X$s, ;Jaslxibs arxlet
<br />D SCRIPTION OF 0PFRA11O.S -I—
<br />.. ......._... a.
<br />E 4 pISEASE P4 fCY L MIT i S
<br />_ -._... .
<br />1:000,00
<br />I
<br />33
<br />I
<br />DESCRIPTK04 OF OPERATIONS I LOCATION$ I VEHICLES (AHtth ACORD 101, Addinnnal Remarks Schoduls, H mate apace In r gWfvd)
<br />Certificate holder named additional insured for general liability as
<br />respects operations of the named insured.
<br />. Q -ram 14112 Did
<br />SANTAA2
<br />f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />_ / THE EXPIRATION DATE THEREOF, NOTICE WITH WILL BE DELIVERED IN
<br />City of Santa AA-,LU' `' ACCORDANCE TH THE POLICY PROVISIONS.
<br />City of Santa AA
<br />20 Civic Center Plaza yasistaat City Attornev
<br />AUTHORiZEO REPRESENTATIVE
<br />Santa Ana, CA 92707
<br />ACORD 25 (2009109)
<br />t 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|