|
A� ° CERTIFICATE OF LIABILITY INSURANCE
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />Page 1 of 2
<br />04/02/2012)
<br />THIS CERTIFICATE IS ISSUED ASA 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 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 endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />Willie of New York, Inc.
<br />c/o 26 Century Blvd.
<br />NAM —_
<br />PHONE E 877- 945 -7378 FA 888- 467 -2378
<br />E -MAIL certificates®avillis.com
<br />P. O. Box 305191
<br />Nashville, TN 37230 -5191
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC #
<br />/1/2012
<br />INSURERA:Greenwich Insurance Company
<br />22322 -001
<br />$ 1,000,000
<br />INSURED Atkins North America, Inc.
<br />INSURERB:American Guarantee & Liability insurance
<br />-
<br />26247 -001
<br />INSURERC:XL Specialty Insurance Company
<br />_
<br />37885 -001
<br />2001 NW 107th Avenue
<br />Miami, FL 33172 -2507
<br />INSURER D: Underwri ter, a at Lloyds
<br />15792 -001
<br />INSURER E:
<br />CLAIMS- MADEFOCCUR
<br />INSURER F.
<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 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 />LIE
<br />TYPE OFINSURANCE
<br />OD'
<br />SUB
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />•
<br />GENERAL LIABILITY
<br />CGG740901601
<br />/1/2012
<br />4/1/2013
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGETO RENTED
<br />PREMISES Eaoccurence
<br />$ 1 000 000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS- MADEFOCCUR
<br />MED_ EXP(Anyone person)
<br />$ 300,000
<br />PERSONAL &ADV INJURY
<br />$ 11000,000
<br />X_ Contractual Liability
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS- COMP /OP AGG
<br />$ 2,000,000
<br />POLICY 7X PRO- X LOC
<br />•
<br />AUTOMOBILE LIABILITY
<br />CAH740901701
<br />4/1/2012
<br />4/1/2013
<br />Eea�1NEDSINGLEDMIT
<br />$ 2,000,000
<br />X ANYAUTO
<br />BODILY INJURY(Per person)
<br />$
<br />�, ALLOWNED SCHEDULED
<br />BODILY INJURY(Per accident)
<br />$
<br />AUTOS AUTOS
<br />HIREDAUTOS NON -OWNED
<br />AUTOS.
<br />P E1 7— A
<br />(Peraccident)
<br />$
<br />$
<br />$
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />AUC92434900
<br />4/1/2012
<br />4/1/2013
<br />EACHOCCURRENCE
<br />$ 25,00 000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 25,000,000
<br />DED '1 X RETENTION$Zero
<br />S
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />CWG740901501
<br />/1/2012
<br />4/1/2013
<br />A U- -
<br />X
<br />Y/ N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? N
<br />N/A
<br />F.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1, 000, 000
<br />(Mandatory in NH)
<br />R yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT Is 1,000,000
<br />D
<br />Professional
<br />B080111209P12
<br />4/1 2012
<br />4/1/2013
<br />$1000,000 Each Claim &
<br />Liability
<br />$1,000,000 Annual Aggregate
<br />Claims Made
<br />11/11/1961 Retrodate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach Acord 1 11, Additonal Remarks Schedule, if more space is required)
<br />�,��rcrc
<br />Effective April 1, 2011, Post, Buckley, Schuh & Jernigan, Inc., d /b /a PBS &J changed its 00
<br />officially to Atkins North America, Inc. '
<br />Greenwich Insurance Co V D %v��
<br />Companies Best Rating A XV
<br />epv©
<br />American Guarantee and Liability Insurance Company Best Rating A XV
<br />XL Specialty Underwriters CLondon aRating;
<br />ats Lloyd's AMe Best A XV. t` E S��Pt r�ey
<br />>,SP
<br />f`COTICIP ATC uru nee _ _ -. _ t
<br />City of Santa Ana
<br />Public Works Agency 14-36
<br />20 Civic Center Plaza, 4th Floor
<br />Santa Ana, CA 92701
<br />ACORD 25 (2010/05)
<br />C011:3685795 TP1:1424620 Cart:
<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 />AUTHORIZED REPRESENTATIVE
<br />/ t n
<br />648162 CcI IQRR -dinin Af`e'lon, -nonnn Atrn►r .
<br />The ACORD name and logo are registered marks of ACORD
<br />Y
<br />
|