|
CERTIFICATE OF LIABILITY INSURANCE
<br />ATE
<br />D06/01/2011 Y)
<br />06/01 /2011
<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(les) 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 LICENSE NO. 0637431
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1290 N. HANCOCK ST., SUITE 210
<br />ANAHEIM HILLS, CA 92807
<br />NAAME: PATRICK MCRAE
<br />a/c°NN Ext: (714) 779-6999 ac Ne: (714) 779-6903
<br />n MAIL p-mcrae@sbcglobal.net
<br />PRODUCER
<br />C T MER ID #:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />5463 DIAZ STREET
<br />IRWINDALE CA 91706
<br />INSURERA: LIBERTY SURPLUS INSURANCE 10725
<br />INSURER B: AMERICAN ZURICH INSURANCE COMPANY 40143
<br />INSURER C: CENTURY -NATIONAL INSURANCE CO. 26905
<br />INSURER D: PEERLESS INSURANCE COMPANY 24198
<br />INSURER E: SCOTTSDALE NSURANCE COMPANY 41297
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 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,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />DGL-LA-184783046
<br />06/03/201106/03/2012EACH
<br />OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �� OCCUR
<br />DEDUCTIBLE:
<br />$5,000 PER OCC
<br />DAMAGE TO RENTED 100,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ -
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />X XCU
<br />X OCP
<br />GENERAL AGGREGATE Is 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />1-1 POLICY XPRO- LOC
<br />EBL EA CLAIM/AGG $ 1,000,000
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />BAP171987
<br />COMPREHENSIVE DED.
<br />$1,000
<br />11/05/201011/05/2011
<br />COMBINED SINGLE LIMIT
<br />(Ea accident) $ 1,000,000
<br />BODILY INJURY (Per person) $ -
<br />X
<br />X
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />COLLISION DED.
<br />$1,000
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />(Per accident)
<br />X
<br />NON -OWNED AUTOS
<br />- $ -
<br />E
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />XLS0074840
<br />06/03/201106/03/2012
<br />EACH OCCURRENCE $ 10,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />' UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />AGGREGATE $ 10,000,000
<br />X
<br />DEDUCTIBLE
<br />$ -
<br />RETENTION $ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />WCO283135403
<br />06/03/201106/03/2012
<br />X WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />FR
<br />E.L. EACH ACCIDENT $ 1 ,000,000
<br />E. L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E. L. DISEASE -POLICY LIMIT $ 1,000,000
<br />D
<br />BUSINESS OWNERS & CONTRACTORS
<br />CBP 8641920
<br />$752,760 BUILDING
<br />EQUIPMENT
<br />$1,000 DEDUCTIBLE
<br />04/10/2011
<br />04/10/2012
<br />$367,200 BPP - $300,000 BI WI EE
<br />COV. INCL. THEFT
<br />$116,318 SCHEDULED EQ.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLESAttach ACORD 101 Additional Remarks Schedule, if more space is reqquired
<br />THE CITY, CITY OF SANTA ANA, ALONG WITH ITS AUTHORIZED AND APPOINTED OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE LISTED AS ADDITIONAL
<br />INSURED AS REQUIERED PER WRITTEN AGREEMENT. INSURANCE AFFORDED BY THE GENERAL LIABILITY POLICY FOR HTE BENEFIT OF THE ADDITIONAL INSURED IS PRIMARY
<br />INSURANCE AS RESPECTS ANY CLAIM LOSS OR LIABILITY CAUSED IN WHOLE IR IN PART BY THE NAMED INSURED(S) OPERATIONS, AND ANY OTHER INSURANCE MAINTAINED BY
<br />THE ADDITIONAL INSURED IS EXCESS AND NON CONTRIBUTORY. 30 DAY NOTICE OF CANCELLATION IN ANY EVENT.
<br />PROJECT DESCRIPTION: MAINTENANCE OF CITY OF SANTA ANA (1315)
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 CIVIC CENTER PLAZA (M-30) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />P.O. BOX 1988 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />SANAT ANA, CA 92702-1988 UTHORIZED REPRESENTATIVE
<br />/ t,PPROVLLD AS TO FORIA
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) Tgg1�l3Qtta logo are registered marks of ACORD
<br />
|