Laserfiche WebLink
.4cr>rrr�• CERTIFICATE OF LIABILITY INSURANCE <br />�---�--�� <br />aATE(MM/DD/YYYY) <br />as/z4/2alo <br />PRODUCER <br />On Risk Insurance services West, Inc, <br />HIS CERTIFICATE IS ISS[IED AS A MATTER OF INFORIMATION ONLY <br />Seattle WA Office <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER THIS <br />1420 Fi fth Avenue t <br />suite 1200 'M ? I 2 f j <br />R LATE DUES NOT AMEND, EXTEND OR ALTER THE <br />Seattle WA 98101-4030 USA <br />GE AFFORDED BY THE POLICIES BELOW. <br />WSURERS AFFORDING COVERAGE <br />a x <br />NAIL # <br />PHONE • 206 749-4800 PAX-(2M Tn7 -4860 <br />INSURED•.- <br />CLE' <br />fin• fidelity & Guaranty ins Co <br />35386 <br />i Frmta: National Union Fire Ins Co of Pittsburgh <br />19445 <br />T-Mobile USA, Inc. <br />its Subsidiaries and Affiliates <br />12920 SE 38th Street <br />Bellevue WA 98006 USA <br />INSURERG Discover Property & casualty ins co <br />36463 <br />INSURER D: Fidelity & Guaranty Ins U/W <br />25879 <br />rNSIJRIIt E: United States Fidelity & Guaranty co. <br />25887 <br />e^°J. <br />7 <br />q <br />COVERAGES STR annlioc nor rorme anti —Airi— of rke .11 , .+ <br />THE P01JCM OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME] ABOVE FM THE POLICY PERIOD INDICATED. NO'TWTITiSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR C7CFER DOCUMENT WITH RESPECT TO WHICH THLS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION'S OF SUCH POLICIES, <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, LIMTS SHOWN ARE AS REQUESTED <br />iNSR <br />In In <br />AD <br />'S <br />TYPE OF INSURANCE. <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />A D DIYYYY <br />POLICY EXPIRATION <br />DATE(MMMOTYYY <br />LIMITS <br />B <br />WJL4LLIABIUTY <br />GL2264628 <br />OS/01/2010 <br />05/01/2011 <br />EACH OCCURRENCE <br />$1.000,000 <br />}C COMMERCIAL GENERAL LIABILITY <br />DAMAGE TO RENTED <br />— S1, 000, 000 <br />CLAIMS MADE ® OCCUR <br />PREMISES (Ea' omarance} <br />1Am me mrson! <br />X Contractual Liability Tncl- <br />PERSONAL& ADV INJURY <br />SI1OC101000 <br />OENERALAGGREGATE <br />S2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER; <br />PRODUCTS - COMPIOP AGG <br />$2.000 , 000 <br />POLICY u PRO- LOC <br />JECT <br />B <br />B <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />CA9835799 <br />AOS <br />CA 9835799 <br />MA <br />05/01/2010 <br />OS/01/2010 <br />05/01/2011 <br />05/0112073 <br />COMBINED SINGLE LIMIT <br />(Eaacudmt) <br />$2,000,000 <br />BODILY R+iJi1RY <br />(Pa Pa ) <br />HIRED.4UT05 <br />NON OWNED AUTOS <br />pI--�I <br />!irI)S�(J�"S: <br />i`? -; i-;1 <br />BODILY INJURY <br />(Pet x©,kut} <br />1H. <br />„' ^ <br />�. � � <br />'�---r—'-""�" <br />,? <br />�-1 <br />-_..._.__-.... <br />PROPERTY DAMAGE <br />(➢a auutmt} <br />IR <br />GARAGE UABILITY <br />ANY AUTO <br />,jai i.�i... <br />I <br />n, ,r•i:., <br />AUTO ONLY - EA. ACCIDENT <br />OTHER THAN EA ACC <br />AUTO ONLY: <br />AGG <br />8 <br />EXCUSI UMBRELLA LIABELl7l <br />15972273 <br />OS/61/2010 <br />Ett7i OCCURRENCE <br />, <br />nX occm ❑ CLAM MADE <br />AGGREGATE <br />55,000,000 <br />DEDUCTIBLE <br />RETENTION <br />A <br />E <br />D <br />WORKERS COMPENSATION AND <br />§' LUB7li7Y <br />PROPRIETOR IPARTNER IEMCUTVE �. <br />OFFIC�RfMEIN$ER EXCLUDED? <br />(M�m �t HE <br />oGDADS - <br />D003w0409 <br />'�= <br />D003WO0410 <br />05/O1j2010 <br />05/01/2010 <br />05/01/2011 <br />05/01/zO11 <br />X STATU- OTH- <br />LIMITS IER <br />E.I,EACH ACCIDENT <br />51.,.000, O0ANY <br />EL DISEASE -EA EMPLOYEE <br />, <br />$l , 000, 000 <br />EL DISFAS$POUCY LIMIT <br />S1,000,000 <br />Ifyo, dao*e nda SPECIAL PROVISIONS below <br />HT <br />OTHER <br />DESCRIPTION OF OPERATIONS4.00ATION&VEMC ESfOU3 USIONS ADDED BY $FStElv'I',S➢ECIAL PROVISIONS <br />Site NUmber/Name: LA338078, Site Address: 1817 W. 21st street, Santa Ana, CA 92706. The certificate Holder is <br />an Additional Insured for General Liability solely as respect to operations of the Named insured at the above <br />location if required by contract. <br />/'L13T7L-i1'1 T'ETYAY Ti!riY <br />City Of Santa Ana SHOULD ANY OFTHE ABOVEINDESCRIBED POLICIES sE CANCELLED BFORE THE EX?mAmm <br />Attu. C1Erk.. Of the COUACII DATE THEREOF; THE ISSUING INSVRERWHi ENDEAVOR TO MAIL <br />20 civic Center Plaza (N-30) 3oDAYS WRIrrENNOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT, <br />PO BOX 1988 BUT FAILURE TO DO $O SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />Santa. Ana CA 92702 USA OF ANY XWD UPON THE DOLM ITS AGENTS OR. REPRESENTATTYES. <br />AUMORIZEDREPRES04TATIVE aM-1'Qb4 .— a..re7reriru wJr. <br />ACORD 25 (2009101) 01988-2009 ACORD CORPORATION. An rights resets <br />The ACORD name and logo are reghftred marlin etACORD <br />.-I <br />rr�4 <br />04 <br />CP <br />E!1 <br />m <br />O <br />O <br />tw <br />te+ <br />a <br />Z <br />a <br />u <br />w <br />i <br />C.d <br />