Laserfiche WebLink
RightFax C3-2 <br />2/9/2011 12:03:33 PM PAGE 2/002 Fax Server <br />,a-~oR°~ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/VYYY) <br />/0 <br />0 <br />/ <br />1 <br /> 2 <br />9 <br />20 <br />1 <br />THIS CERTIFlCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RI <br />GHTS UPON TH <br />IFlCATE HOLDER. THIS <br />E CERT <br />t <br />Q <br />~j <br />E <br />F <br />~ <br />O <br />TH S CERTIFICAT <br />NSU <br />OF <br />RANCE DOES OT CONST TUTS A CONTRACT BETWEEN THE SIN~~R(fA~H~RIZED REPRESENTAT <br />IVE <br />OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: li the certificate holder is an ADDITIONAL INSURED, the policy(ies) must bee end. if SUBROGATION ~; AIVED, subject to the <br />~{~, r : ~ x <br />t <br />d <br />diti <br />h <br />li <br />n <br />' <br />~ <br />erms an <br />con <br />ons of t <br />e po <br />cy, certain policies may require an endorsement. A state i 6 <br />this certlTicate <br />~ does <br />t confer rights to the <br />certHicate holder in lieu of such endorsement(s). - ! " ' <br />PRODUCER CONTACT <br /> NA <br />AUTOMATIC DATA PROC INS AGCY INC (A/C, No, En): (s77 677.0428 A/C, No : 87 677-0430 <br />71 HANOVER RD _ <br />FLORHAM PARK <br />NJ 07932 /~ Es : s rbicad avelera.com <br />, <br />(877) 677-0428 ~~ ~j~J ~~ PRODUCER <br />I ~ 6s9aDetxe <br />XV770 70A <br />INSURER(S) AFFORDING COVERAGE NAlcp <br />INSURED INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA <br />CONSENSUS, INC <br /> <br />626 WILSHIRE B <br />1 INSURER B: <br />000 <br />LVD. # <br />LOS ANGELES <br />017 <br />CA INSURER C: <br />, <br />90 INSURER D: <br /> INSURER E: <br /> INSURER F <br />COVERAGES CERTIFICATE NUMBER: oos6939osa21 oao REVISION NUMBER: <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, EXCLUSIONS <br />AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />NSR <br />LTR <br />TVPEOFINSURANCE ADD <br />INSR SU BR <br />POUCVNUMBER POLICY EFF <br />MM/DD/YVYY POLICY EXP <br />MIU/DD/VYYY <br />LIMITS <br /> GENERAL LIABIITY <br />EACH OCCURRENCE <br />$ <br /> COMMERCIAL GENERAL LIABILITY PAMAI rr ~ <br /> CLAIMS-MADE ~ OCCUR MED EXP An one arson $ <br /> <br /> PERSONALS ADVINJURV $ <br /> <br /> GEN'LAGGREGATE LIMIT APPLIES PER: <br />y) y A <br />PRODUCTS -COMP/OP AGG <br />$ <br /> PRO- <br />POLICY T LOC ~~ ~,~ TU ~ S~1V1 $ <br /> AU TOMOBILE LIABILITY <br />_ <br /> <br />~ COMBINED SINGLE LIMff <br />(Ea aceideni) $ <br /> ANY AUTO <br />ALL OWNED AUTOS ~ ~ ~ <br />~ BODILY INJURY (Per person) $ <br /> <br /> <br />SCHEDULED AUTOS <br />Laura y <br />flit SrleeC <br />Tle <br /> <br />~ <br />BODILY INJURY (Per accdent) <br />$ <br /> <br />HIRED AUTOS <br />Assistant <br />Clty AltOr PROPERTY DAMAGE <br />p~ accident) <br />$ <br /> NON-0WNED AUTOS $ <br /> $ <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESSLIAB CLAIMS-MADE AGGREGATE $ <br /> DEDUCTIBLE $ <br /> RETENTION ~ $ <br />A WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N N/A UB-90810486-11 01/01/2011 01/01/2012 X T RYTIAMIT OTR <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE^ <br />OFFICERMIEMBER EX <br />? E.L. EACH ACCIDENT $1 000,000 <br /> CLUDED <br />(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 <br /> li yes, describe under <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT <br />$ 1 ,000,000 <br /> <br />DESCRIPTION OF OPERATIONS /LOCATIONS! VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, if morespace is required) <br />r u rvr~r ~ r rvw~n <br />CITY ATTORNEY <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA (M-29) <br />PO BOX 1988 <br />SANTA ANA, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE <br />WITH THE POLICY PROVISIONS. <br />AUTHOPoZED REPRESENTATIVE ~ ' ~~~, <br />®1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />