CAPOUYA, LYNN-2009 - Laserfiche WebLink

Home Browse Search

rD —fli- 1171717 ACORDTM CERTIFICATE OF LIABILITY INSURANCE lN5K LTR ADD' N 8106 /2 o°IYYYY' PRODUCER BB &T Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Of Orange County 680 Langsdort Drive Suite 100 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. A Fullerton, CA 92831 INSURERS AFFORDING COVERAGE NAIC # INSURED � /'� Lynn C Mitchell Inc. `-11J► 17992 Mitchell South, Suite 110 Irvine, CA 92614 INSURERA: Hartford Casualty Insurance COm 29424 INSURER B: Hartford Ins Co of the Midwest 37478 INSURERC: Property & Casualty Ins Co of H 34690 INSURER D: DAMAGE TO RENTED PREMISES (Ea occuirrencel INSURER E: MED EXP (Any one person) $10,000 VVY THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lN5K LTR ADD' N TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE M D POLICY EXPIRATION DATE M D LIMITS A GENERAL LIABILITY 72SBAKN6524 07/10/09 07/10110 EACH OCCURRENCE $2 000 000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR DAMAGE TO RENTED PREMISES (Ea occuirrencel $300 OOO MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2 000 000 GENERAL AGGREGATE $4000000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F1 PECa LOC PRODUCTS - COMP/OP AGG $4,000.000 C AUTOMOBILE X LIABILITY ANY AUTO 72UECAH1867 07/20/09 07/20110 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ ��,,�� a 1` (� AS T T �' FORM PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO Laura Stitt i1Led AUTO ONLY - EA ACGDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE AsSistait a�1ty , -' ( {rT {- 8y EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 72WECRRO814 08/01/09 08/01/10 X I WC STATU- I OTH- E.L. EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Oyes, describe and EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 SPECIAL PROVIII SIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Cancellation clause is completed as follows: except in the event of Non Payment when a 10 day notice will be provided The City of Santa Ana, its officers, employees, agents, volunteers and representatives are added as Additional Insured per pages 10 -17 of coverage form SS0008 0405 attached. Covreage is primary and any insurance maintained by the additional insured shall not contribute. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Of Santa Ana Public Wi51'k§ Agency M -36 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. BOX 1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Santa Ana, CA 92702 REPRESENTATIVES. cannon � OUTHOR¢ED REPRESENTATIVE h L i I of A 40it14- 100 limits ly610 TLAMS ® ACORD CORPORATION 1988