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WESTFALL, MATTHEW - 2009
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WESTFALL, MATTHEW - 2009
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Last modified
1/19/2017 1:45:39 PM
Creation date
6/8/2009 12:39:01 PM
Metadata
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Template:
Contracts
Company Name
WESTFALL, MATTHEW
Contract #
N-2009-053
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Expiration Date
6/30/2010
Insurance Exp Date
6/1/2010
Destruction Year
2018
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lar14 23 zLa +€, ; ' 1� -> 4 The Hartford Fax Pa V rN;V <br />- 3 � CERTIFICATE OF LIABILITY INSURANCE M217 <br />2 nar <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORVA- C, <br />1C t' 'r• T'i;'C'R S,?�'C E HGFiVCY INC/PA'S ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA"k <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND <br />2143-1430 F:(677)905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIESR;.15 <br />INSURERS AFFORDING COVERAGE <br />77 7P245 <br />w: fiF:• INSURER A; Hartford Casualty Ins Cc <br />INSURER S: <br />INSURER C. <br />7 INSURER E' <br />IivSi;R^ NCS LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NCTWQIici?:' <br />`fiF tl OR C.ONCJTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE IS -:c <br />�1 .i S' J +H.NGa AFFCROED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDiT:ON4 u,: <br />:cp,4Tc iMI S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />1 <br />011 <br />1 <br />CY Cmggl ' POL/CY O(PlRAT/ON <br />POLICYNUM9ER ! L!M175 <br />;E, A. uAsl_r j 65 SBM NW4998 06/01/09 06/01/10 jFREDAMAOE:AIYon. nret ie30n_ r <br />MED EXP {Ary 0119 Ver eor} a 10 , 0 r <br />PERSONAL & ADV NJ1JR`r s 1 rY /•, ,;• <br />GENERAL AGGREGATE a L l <br />-1 09 r QF E3'ER PRODUCTS - COMP/OP AOa s 2 J J l} • C G <br />COMBINED&NGLE L MT <br />iEa accident) � � <br />BOO LY 'INJURY <br />'S e <br />u .,. {Per personl <br />' 90DILY 'NJURY 9 <br />Per sod enT) <br />APPROVED AS TO FOR <br />1 PRDPERT� DAMAGE <br />IPer accident) <br />AUTO ONLY - EA ACG DEN7 <br />_._ <br />a <br />OTHER THAN ❑H ACC. . <br />OW111&11 11ON AIDC <br />ura stJlt 1. <br />ant �6y Attorney <br />AUTO ONLY! __AGG <br />EACH OCCURRENCE <br />A30REDAT` <br />VJC ST <br />E.L. EACH ACC'.D' <br />I E.L. DS -AS: - EA <br />J <br />1 <br />ER ' <br />IT <br />MPLO"-E <br />C"LMT a <br />I <br />.J .. CC` CIF4 „P 'i''t 4710Af51VVNCLES1E=U5ANVS AODE'D BY END0R59MFM/8PEGIAL PROVIS/ON8 <br />... i- Insured's Operations. City of Santa Ana, its officer; , <br />._ r :_.:>✓ee.~ representatives, and volunteers are Additional In- _1 <br />i,iai.)ility Coverage Form SS0008 . Coverage is primary & <br />r • ..'r'.:_ -:.J,n v the Business Liability Coverage Form. SS0008. Please �=e <br />`.rc L pay for complete wording: <br />AT: 10 1,:: -; �{_ ADATIONALINSLMID;INSUR,•RLtmw A CANCELLATION <br />r v } SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL U Ef <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDE> <br />`:L On, & Community services 130 DAYS WRITTEN NOTICE {10 DAYS FOR NON-PAYMEN T I -0 TF <br />�,_,,.. 1 !HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMn;,k,iSL :� <br />OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, :TS AG R <br />_''•:iX ! 88 M - "F 3 ,REPRESENTATIVES. <br />�" A C 0 R 0 C0R"C"? <br />
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