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<br />-`?coRO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />??? 03/23/201 1
<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, ANDTHE 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 CONTACT
<br />NAME:
<br />MARSH USA INC. _ __ _ _ _ _ __ -_ _ _ _ _
<br />PHONE-- - _- _ - - - Ax
<br />ONE STATE STREET ?C Ng-Extl __-- -_- - _ _ _ -___ to/C,_N? _ _ -
<br />-
<br />HARTFORD
<br />CT 06103-3187 E-MAIL
<br />, ADDRESS:
<br /> INSURERSS) AFFORDING COVERAGE NAIC #
<br />-.._ -- INSURER A :HarttOrd Flre InSUra nCE L:O ?an?_ 19682
<br />INSURED INSURER B :The Insurance COmpa?Of the State of Penns /ZVanla '1
<br />9429
<br />AMTECH ELEVATOR SERVICES .
<br />--- - - -- -- ---
<br />1550 S. SUNKIST ST, SUITE A INSURER c :Illinois National Insurance Co. 23817
<br />ANAHEIM, CA 92806 -- - - - - --
<br /> INSURERD Chards Casua[?Ompany _._ 40258 -
<br /> INSURER E New Ha mpshve Insurance Company___ 2384'1
<br /> INSURER F :National Union Fire Insurance Com an of Pittsbur h, PA 19445
<br />COVERAGES CERTIFICATE NUMBER:uRJ H6S3F 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 MAV BE ISSUED OR MAV 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 />INSR ? ? -- -- AODL SUBR POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE IN R WVD POLICY NUMBER MM/DD/YYW MM/DDNYW LIMITS
<br />A GENERAL LIABILITY 02CSET10004 04/01/2011 04/01/2012 EACH OGGURRENOE $ 1.000,000
<br /> X COMMERCIAL GENERAL LIABILITY $2,000,000 general a re ate
<br />99 9 per
<br />' DAMAGE TO'RENTED
<br />PREMISES (Ea occur ence)
<br />$ 300 000
<br />
<br />? location/pro
<br />ect
<br />0
<br />10 000
<br /> CLAIMS-MADE
<br />OCCUR $10,000,0
<br />policy general aggregate MED EXP (Any one person) $ ___- -
<br /> PERSONAL 8 ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000
<br /> X POLICY PRO LOC $
<br />A AUT OMOBILE LIABILITY 02CSET10000 ((A/O) 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT
<br />1
<br />000
<br />000
<br /> 02CSET10019 (HI) SEa cc?darnZ_ $ __
<br />.
<br />,
<br /> X ANY AUTO Hartford Underwriters Ins BODILY INJURY (Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY (Per accitlenq $
<br /> AUTOS AUTOS
<br /> NON-OWNED PROPERTY DAMAGE $
<br /> HIRED AUTOS
<br />AUTOS Peracopen?__.__-
<br /> S
<br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $
<br /> DED RETENTION $ $
<br />B WORKERS COMPENBATION 061967:CA-369 04/01/2011 04/01/2012 X p
<br />O
<br />
<br />C
<br />AND EMPLOYERS' LIABILITY y / N
<br />FL-370 TX-371 RY.LIMITS...
<br />E F:.
<br />-. - -
<br />D ANY PROPRIETOR/PARTNER/EXECUTIVE MULTI-368 E.L EACH ACCIDENT $ 1,000 000
<br />E OFFICER/M EM BER ExCLU DED? ? N / A MA367;MN375;NJ374;MULTI372,373 -- --- -- -- --- --
<br />F (Man,ia[ory m NH) CT WC (SIR 2.SMM) EX COV- E1 DISEASE EA EMPLOYEE $ 1 •000 000
<br /> If yes dascr ba untlar 1192382 -- - - - - - -- - __-- ---
<br />1
<br />000
<br />000
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT ,
<br />,
<br />$
<br /> I $
<br /> $
<br />
<br />
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 10t, Atltlltional Remarks Scha,fula, if more space Is raqulratl)
<br />This certificate only applies to City Hall, 20 Civic Center Plaza -Santa Ana Library, 26 Civic Center Plaza, City Hall Annex, 24 Civic Center Plaza -Corporate Yard, 215 S.
<br />Center Street -City Hall, 20 Civic Center Plaza (Wheelchair Lift) and Santa Ana Zoo, 1801 Chestnut Place.
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are additional insured to the extent required by contract. The coverage afforded is primary
<br />and non-contributory to the extent required by contract.
<br />contract number: DVB-06416
<br />CERTIFICATE HOLDER CANCELLATION
<br />APi RU V???
<br />? SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />AS
<br />T(J (: (
<br />, 1?? THE EXPIRATION DATE TH EREOF, NOTICE WILL BE DELIVERED IN
<br />? ACCORDANCE WITH THE POLICY PROVISIONS.
<br />??
<br />"G. ?
<br />City of Santa Ana -?'?^"? AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza La LLI'a. S y ---
<br />Santa Ana, CA 92702 t Sil %?.d - ?i :` ?j?S ?`?
<br />i+??).,tant Lit fv
<br />- Page 1 of 1 ©'1988-201 O ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (20'10/05) The ACORD name and logo are registered marks of ACORD
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