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SBACO OP 110- NC
<br />n, rr YI
<br />CERTIFICATE OF LIABILITY
<br />0310912016
<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 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 NAME: Clem J. WVand'risco
<br />Henderson Brothers, Inc.
<br />920 Pt Duquesne Blvd
<br />PHONE -.... _.... ,.. __ _ -. , fAX D
<br />(AIC, No, Ext); 412 -261 1$42 Iarc, Na). 412W- 2 1-414
<br />Pittsburggh, PA 16222
<br />EMAIL
<br />ADDRESS: cjwandrisco @hendersonbrothers .cam
<br />- -.
<br />Clem J. Wandriaco, Ill
<br />INSURERS) AFFORDING COVERAGE NAIC N
<br />'"COrporatiOPN ............. _
<br />INSURER Property Casualty Ca 25674
<br />_ ....
<br />INSURED .. + SBA. ComIIriliInIGations
<br />INSURER B: St Paul Fire ter` Marine Ins Cc .;24767
<br />Thomas Hunt, Esquire
<br />RC:lllinais Union Insurance Carrrpa
<br />6900 NW Broken Sound Parkway
<br />-NSU
<br />Boca Raton, FL 33487
<br />INSURER D:
<br />{'i PE[15WNALL B ADV INJURY
<br />INSURER E:
<br />INSURER f :
<br />COVERAGES rFRTIFICATF NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT' WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR _ A001. SUER
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />1
<br />POLICY EFF .POLICY EX
<br />MMIDDIYYYY MMIDDIYYYY LIMITS
<br />GENERAL LIABILITY
<br />I EACH OCCURRENCE '
<br />$ 900,00'
<br />A X COMMERCIAL GENERAL LIABILITY X
<br />TJEXGL474M8138TIL16
<br />r
<br />aAMAGE'TO kLKTELI -' -..._ ,
<br />0311612016 0311512016 PRrmMIS�S (Ea pctgrence )
<br />$ 900,00
<br />—
<br />CLAIMS-MADE D OCCUR
<br />i ., [_X
<br />I
<br />4
<br />,.. _..
<br />X 1$100,040 SIR
<br />{'i PE[15WNALL B ADV INJURY
<br />.$ _._9'0'0 00
<br />I
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />GEN "L AGGREGATE LIMIT APPLIES PER
<br />PR
<br />PRODUCTS - C
<br />JDi9MPfOP AGO$
<br />_ OD _.
<br />2,000,00
<br />.. POLICY I X, i JECT i LOG
<br />AUTOMOBILE
<br />LIABILITY {
<br />C a accid n SINGLE LIMIT
<br />1,000,000
<br />I
<br />A X
<br />ANY AUTO { 1 'I'C2JCAP474M814
<br />0311612016 BODILY IN (Per person)
<br />$
<br />.._ _ {
<br />ALL OWNED SCHEDULED
<br />1 BODILY INJURY (Per acckfanl)
<br />$
<br />X
<br />AUTOS AUTOS
<br />NON•CWNEL7
<br />X+I
<br />I PROPERTY �AiWIAGF.._ m ._ .-
<br />ACCA)ENT1
<br />$
<br />XX
<br />HIRFL? AU1'i7S AUTOS
<br />100,00 Et) HCPD
<br />(PER
<br />r
<br />_....... _
<br />$ ..
<br />UMBRELLA LIAR
<br />� OCCUS-MADE
<br />EACH OCCURRENCE
<br />$ 26,000,00 _
<br />-.. ,.. ...... _
<br />B ��
<br />EXCESS LIAR ZUP16N3740616NF
<br />03116/201510311612016 AGGREGATE
<br />$ 26,000,00
<br />101ti00�,
<br />WORKERS CDMPENI3ATI17NN.$
<br />WC Sl °ATU- OTH-
<br />X LIMIT EFt
<br />AND EMPLOYERS LIABILITY Y Y N j
<br />A ANY PRGPRIETORIPARTNERIeXECUTIVEI (
<br />"fi I TC2JUB�It %6Mrt37816 AOa�7)
<br />�TR,IU'B476M43BA16
<br />0311612016 0311512016
<br />I
<br />.TORY
<br />E L. EACH ACCIDENT
<br />$ 1,000 00
<br />.. _ --
<br />OFFICERIMEMBEREXCLUL7E l..N
<br />A (Mandatory IFI NH) It 1
<br />03115120166 ; 0311612016
<br />E.L. DISEASE - EA EMPLOYEq
<br />$ 1,000,000
<br />II es, describe under
<br />D SCRIPTION OF OPERATIONS below
<br />E,L, DISEASE .. POLICY LIMIT
<br />$ 1,000,000
<br />C IPROFESSIONAL COOG24641800005
<br />0311512015
<br />0311512016
<br />CLAIMIACG
<br />5,000,00
<br />POLLUTION
<br />SIR
<br />100,00
<br />LOCATIONS SiteeName: Salvador Additional
<br />Center, 18251PC more ivicc required)
<br />Site Number: CTA1 r9 C+enterDr.,,��•��"`
<br />er:
<br />Santa, Ana, CA
<br />�wt�
<br />q,
<br />tO
<br />I,NdtZL01114014V
<br />CA46019
<br />City of Banta Ana, Executive
<br />Director Perks, Roe and
<br />Community Services (M -23)
<br />26 Civic Center Plaza, M -76
<br />Banta Ana, CA 92701
<br />SHOULD ANY CIF 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 />i4V I'V00 -4U'IU M%,Vr%L.7 I..VI°ar'Vicre I IVIV. HIF r1gl Ills FVZJeFYCLI...
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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