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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE D03
<br />(21
<br />2
<br />)
<br /> 1FK495WM /
<br />/
<br />009
<br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />MARSx usA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />ONE STATE STREET
<br />' HOLDER.THIS CERTIFICATE DOES NOT AMEND
<br />EXTEND OR
<br />... HARTFORD, CT 06103-3187 ,
<br />ALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW.
<br />
<br />-- --_ _-_ 71~'`" F~t~~
<br />_-- --- } ~ ~,!'1 zg: ~ ~j
<br />-----_, INSURERS AFFORDING COVERAGE I NAIC #
<br />_ -
<br />
<br />INSURED - - - - -- f-_- ---__
<br />INSURER A Hartford Fire Insurance Co
<br />OTIS ELEVATOR COMPANY .- ---- - -
<br />ONE FARM SPRINGS ROAD ~ ~ E `' ~'}
<br />'„~ t1 . INSURER B:Ins Co of the State of PA
<br />FARMINGTON, CT 06032 ~ _.
<br />((~~
<br />:
<br />f~~a _
<br />`
<br />_ - - --
<br />'t, INSURER C:Illinois National Ins Co.
<br />~
<br /> .
<br />_ (INSURER D:American International South Ins Co
<br /> INSURER E: New Hampshire Insurance Co
<br />OVERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BYTHE 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 />INSR A D'
<br />LTR NSR
<br />TYPE OF INSURANCE
<br />POLICY NUMBER ~: POLICY EFFECTIVE
<br />'': DATE MMIDD ~~ POLICY EXPIRATION
<br />I DATE MMlDD/YY
<br />LIMITS
<br />A GENERAL LIABILITY 02CSET10004 ~!I 04/01/2009 04/01/2010 !EACH OCCURRENCE $ 1, 000, 000
<br /> X COMMERCIAL GENERAL LIABILITY ~ ', PREMISES Ea occurence
<br />~-L
<br />- $ 300, 000
<br />
<br />-
<br />-
<br /> CLAIMS MADE X OCCUR $2,000,000 general
<br /> MED EXP (Any one person)
<br />- - $ 10 , 000
<br />
<br />aggregate per
<br />' _. _ ___..
<br />
<br />--
<br />-- pERSONALBADVINJURY $ 1 000,000
<br /> - location/project ---- ---- --
<br /> _ 'GENERAL AGGREGATE $ 2,000,000
<br /> ___ _
<br />GEN'LAGGREGATE LIMIT APPLIESPER:~
<br />$10,000,000 policy I
<br />^PRODUCTS-COMP/OPAGG
<br />--- ----- ~-
<br />"$ 2,000,000
<br />+- - -
<br /> X POLICY PRO- LOC !
<br />A ~' AUT OMOBILE LIABILITY 02CSET10000 (A/O) 04/01/2009 I
<br />04/01/2010
<br />
<br />X
<br />ANY AUTO
<br />02CSET10019 (HI) I
<br />' COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br /> (! Hartford Underwriters ' -
<br /> ALL OWNED AUTOS ,
<br />'
<br />I
<br />
<br />;
<br />Ins
<br />I BODILY INJURY
<br />$
<br /> SCHEDULED AUTOS (Per person)
<br /> HIRED AUTOS I ~~
<br />' ' - -- ---
<br />
<br />NON-OWNED AUTOS ;BODILY INJURY
<br />(Per accident)
<br />$
<br /> (, ~y
<br />~~ `} ~
<br />' `~
<br />(~ y ~L ~ T~
<br />~ .) ~ A ~ ~~ ~-- -- - --- -
<br /> i ~, _. -_ -
<br />_ PROPERTY DAMAGE $
<br /> (Per accident)
<br /> ~ RAGE LIABILITY I
<br />
<br />A t f % / ~
<br />
<br />
<br />`
<br />/ i
<br />~ I, ~_ _.__
<br />EAACCID
<br />$
<br /> ANYAUTO ~
<br />.•~..••• F'
<br />J
<br />I _--
<br /> `
<br />r
<br />l~ nCCd AACC
<br />N $
<br /> .. ,i.::
<br />Ytt y AUTOON~Y
<br />AGG --
<br />$
<br />'~, EXCESS/UMBRELLA LIABILITY I~ ~ ~ ~ ~ ~~ ' j
<br />~ EACH OCCURRENCE ~ $
<br /> OCCUR ~ CLAIMS MADE AGGREGATE ' $
<br />I !
<br />I
<br />-- -~~- -- $
<br /> DEDUCTIBLE
<br />- - --_
<br />--
<br /> I RETENTION $ ' $
<br />--
<br />B j WORKERSCOMPENSATIONAND 35669:MA, NJ-20, CA-24 ~!. 04/01/2009 04/01/2010 X
<br />A
<br />
<br />C ORY I
<br />MITS ER ____
<br />EMPLOYERS' LIABILITY TX- 21 , FL- 2 8 I 'I
<br />
<br />O ANY PROPRIETOR/PARTNER/EXECUTIVE I EL EACH ACCIDENT '~. $ 1, 000, 000
<br />(
<br />y
<br />
<br />I OFFICER/MEMBER EXCLUDED?
<br />MULTI-23, OR-25 ~'~... jE.L.DISEASE EAEMPLOYEE
<br />'$ 1,000,000
<br />E lfyes,desaibeunder IMN-22, MULTI-26, 27
<br />
<br />SPECIAL PROVISIONS below
<br />E.L. DISEASE-POLICY LIMIT i$ 1,000,000
<br /> OTHER
<br />i
<br />DESCRIPTION OF OPERATIONS (LOCATIONS /VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
<br />CT WORKERS COMPENSATION (SIR 2.5MM) EXCESS COVERAGE - NATIONAL UNION FIRE INSURANCE CO - POLICY NO. 4801324
<br />City of Santa Ana Police and Holding Facility, Santa Ana, CA 92702.
<br />The City of Santa Ana, its officers, agents, volunteers, and employees are additional insured on the above Commercial
<br />General Liability as required by contract. The liability coverage afforded is primary and non-contributory.
<br />contract number: SAN 05208
<br />_ -_ __ _- _ __ __ _ --____.- Vf11~VCLL/111VI\
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />DATETHEREOF,THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE
<br />CERTIFICATE HOLDER NAMED TO THE LEFT.
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2001/08)
<br />AUTHORIZED REPRESENTATIVE _ I' _r ~~~ `~
<br />Page 1 of 1 ~~
<br />© ACORD CORPORATION 1988
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