BRODERICK, JAY 1 - 2011 - Laserfiche WebLink

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BRODE -3 OP ID: NR i� ;C� C��L�- '�� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD /WYY) 06/12/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder in Ileu of such endorsement(s). PRODUCER 419 -255 -1020 Hylant Group Inc - Toledo 811 Madison Ave 419- 255 -7557 Toledo, OH 43604 Jeannie Y. Hylant NAME: PHONE Afc No Ext � ac No E -MAIL ADDRESS: LIMITS GENERAL LIABILITY INSU RER(S) AFFORDING COVERAGE NAIL M INSURER q � Philadelphia Indemnity Ina Co 1 $(]5$ INSURED Jay Broderick dba Mad Science of West Orange County INSUR BZ B :Twin City Fire Ina uren ce Co 029459 X COMMER CIAL GEN ERAL LIABI LITY CLAIMS -MADE � OCCUR X 3501 W Moore Ave, Ste J INSURER C 10/15/11 Santa Ana, CA 92704 INSURER D $ 300,000 INS VRER E $ `15,000 N _ �� _ � � INS VRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BV PAID CLAIMS. INSR LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NVMBER POLICY EFF MM /DDIYYYY POLICY EXP MMfDDNWY LIMITS GENERAL LIABILITY 26 Civic Center Plaza Santa Ana, CA 92701 EACH OCCURRENCE $ 1,000.000 A X COMMER CIAL GEN ERAL LIABI LITY CLAIMS -MADE � OCCUR X OO 1988 -2010 ACORD CORPORATION. All rights reserved. PH PK772381 10/15/11 10/15/12 PREMISES Ee occurrence $ 300,000 MED EXP (Any one person) $ `15,000 X AbusefMOleafetlon PH PK 772381 10/15!11 10/15/12 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000.000 GEN'L AGGREGATE LIMIT APPLIES PER'. PRODVCTS- COMP /OP AGG $ 2.000.000 POLICY PRO LOC JECT R M $ 500,000 AUTOMOBILE LIABILITY Ea eBCO aeDt SINGL LIMIT $ 1.000.000 BODILY INJURY (Per person) $ A ANY AUTO PHPK772381 10/15/11 10/1 5/12 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accidenq $ HIRED AUTOS X NON -OWNED AUTOS X PROPER V AMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PRO PRIETO R/PARTNER/EXECUTI VE Y / N OFFICER /MEMBER EXCLUDEDy � NIA SWEC BH66O9 1 0/1 5/11 10/1 5/12 WG STAT U- OTH- X TORY LIMITS ER E.L_ EACH ACCIDENT $ 1.000.000 E.L. DISEASE - EA EMPLOYE $ 1.000.000 (Mend efory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACDRD 10'I, Ad tlificnal Re marke Schedule, if mare apace is required) City o£ Santa Ana its o££icers, agents and employees are included as an di ti oral Insured der Form CG2010 _ Coverage is on a primary and � 3� ^�7 r�� <rT7 T) �� Tn r- •'(�l��fj noncontributory basis except £or gross negligence or wanton and wi11£u1 �� misconduct Assistant City A110ruc�� a-.�rt I Irw.•+.I C 1"IVLUGR GANG tL LAI IVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTCE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 26 Civic Center Plaza Santa Ana, CA 92701 AUT P_�R-- ESEN / /TTA \'TIVE /HJOr`R�I ^ZE ^lD/ -RNE / - ) i� U OO 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD