Laserfiche WebLink
2'j�)bUl <br />A�iGi°'Rbr CERTIFICATE OF LIABILITY INSURANCE <br />�.A <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 polioy(les) must be endorsed, If SUBROGATION IS WANED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate dons not confer rights to the <br />certificate holder In Ilau Of Ruch endorsement a . <br />PRODUCERr'4ZTaff <br />Rocio Leon <br />John 0. Broaw Co. / #0425149 <br />3636 American River Drive Mte 200 <br />Sacramento, CA95864 <br />ENDIVE 916-480-4134 916-4844134 <br />L . doenOohnObnmsun.Dom <br />74-78 <br />916.974-7800 <br />INSURE AFFORDING COVERAG E NAIC$ <br />INSURERA: Financial PacWclnsurance CD(Sanramento,CA) <br />31453 <br />INSURED Were DispD6al Inc. <br />INSURER a : Houston Casualty Co (Bums & Wilcox San Pranciso <br />42374 <br />INS RERC: Alaska National Insurance Cc (San Francisco, CA) <br />39733 <br />(See below for addillodal Named hLsureds, if any) <br />P.O. Box 8099 <br />Newport Beach, CA 92658 <br />INSURER D :, Evmaton loS CO (Boma & Wil=, San Francisco) <br />35378 <br />NSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: RPMAInN MI MANOR. <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BCLOW 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 />ILTR NSR <br />TYPE OF INSURANCE <br />INSR <br />WW1 <br />POLICYNUMBER <br />POU EFF <br />IMMIDDrrCM <br />UMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE �OCOUR <br />X $I,000Per Occnrnlnw PDDed. <br />X <br />60425093 <br />Per Project Aggrcgateapplies per <br />written contract <br />20/13 <br />2128114 <br />EACH OCCURRENCE <br />$ 1,0Iq,00D <br />OAAIAGE TOREMM <br />I E Eaeonmence <br />MEOFOCP M n <br />$ 100,B00 <br />$ 5,000 <br />PERSONAL d AAV INJURY <br />S 1,OWODD <br />GENERALAGMEGATE <br />a 2,000,000 <br />GEN'L AGGREGATE <br />POLICY <br />LIMIT APPLIES PER <br />X oT LOp <br />EBODUCTS,COMPIOPArr <br />S 2,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />60425093 <br />2728/13 <br />2/28/14 <br />EnacWdm W T <br />L000000 <br />$ <br />X <br />BODILY INJURY(Pw pdn=), <br />A <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />ED <br />HIRED Alir06 X NOR -OWNED <br />$5,0W HVPD Deductible <br />BODILY INJURY(Pefacdtlenh <br />f <br />X <br />ROPa OANLIOE <br />Pa <br />$ <br />$ <br />UMBRELLA UAB <br />X <br />OCCUR <br />H13XC50223-00 <br />212g/13 <br />2nV14 <br />EACH OCCURRENCE <br />$ 51()WI000 <br />X <br />AGGREGATE <br />S 5100010OD <br />B <br />EXCESS UAR <br />CLAIMS -MADE <br />(Ist Layer) <br />RETEtMON 11S <br />(" <br />WORKERS COMPENSATION <br />ANDEMPLOYERS•LIABILRY YIN <br />ANY PROPRIETORIPARTNEPoFJ(ECUTNE <br />OFFICERMEMBER EXCLUDED? <br />(Mandatory In NH) <br />IP deeaine ender <br />p RIPnON OFOPERATIONSt)Glbtl <br />N/A <br />13HWS05450 <br />S/01f13 <br />8/01114 <br />X WC STATL'- OTN- <br />E.L. EACH ACCIDENT <br />s 110001OW <br />-EL DISEASE-EAEMPLOYE <br />$ 1,0()0,()00 <br />IEL. DI6EASE •POLLCVLIMB <br />$ 11000000 <br />D <br />Suess Liability - tad Layer <br />XOBW4359113 <br />2129113 <br />2f2$/14 <br />$5,000.000 Each Occunenc;a35,ODO,OOO Agg <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VBNICLES (JUWt ACORD Tel, Addtnonal Ramerks Sahodula, Kmma apace In mqulrad) <br />RE: WorLpedomledby the insured for certificate holder per written contract APPROVEDAS TO .FORM <br />Addy City of Santa Ana; its officers, employers, agents, volunteers and representative /" , <br />T <br />{ <br />F ...�'a_ 12 <br />artastss <br />:IJ',�e� <br />Forms, CG2010R1211,CG7t54O1W Laura S' Sheedy <br />ra S L---mo.._.�... <br />'A- Sistant it Attornev <br />City of Santa Ana Public Works Agency <br />20 CIVIC CENTEIR PI ABA M-21 <br />SANTA ANA, CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />flMT =I <br />