|
p -11W1 - �0 -C
<br />tk. R CERTIFICATE OF LIABILITY INSURANCE
<br />��0252011
<br />FIIA'J��IMMJO2011,
<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(iesl 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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Tutton Insurance Services
<br />WC No tar. (949)261-5335 FAC No: (949)261-1911
<br />2913 S. Pullman St.
<br />A SS:
<br />AOIa
<br />PRODUCER 00002827
<br />U TO s.
<br />CUSTOM
<br />INSURER(S)AFFOROING COVERAGE NAICi
<br />Santa Ana CA 92705
<br />INSURED
<br />INSURERA :Starr Indemnity b Liability 8318
<br />INSURER B:PeerICSS Insurance CouIpany 24198
<br />Environmental Engineering 6 Contracting, Inc.
<br />INSURERC:QOldien Eagle Insurance 10836
<br />501 Parkcenter Drive
<br />INSURERoNational Union Fire Ins. Co. 19445
<br />NSURERE:
<br />Santa Ana CA 92705
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER:11/12 Liab 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 />TYPE OF INSURANCE
<br />ADDL
<br />SUBRI
<br />POLICY EFF
<br />POLICY NUMBER MMI
<br />MW I E%
<br />LIMITS
<br />Santa Ana, CA 92701 :.:i:t �I,[s
<br />GENERAL LABILITY
<br />Stanley Tutton/CLAUDI
<br />EACH OCCURRENCE $ 5,000,000
<br />UAMAGIZ TO RENTED
<br />PREMISES occurrence) $ 100,000
<br />A
<br />X COMMERCAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />SISEIL70065111 0/31/2011
<br />0/31/2012
<br />MED EXP (Any one person) $ 25,000
<br />PERSONAL 6 ADV iNJJRY $ 5,000,000
<br />X Vo Deductible
<br />GENERAL AGGREGATE $ 5,000,000
<br />GEN'L AGGREGATE LIM IT APPLIES PER,
<br />PRODUCTS - COMP/OP AGG $ 5,000,000
<br />PRa LOC
<br />X1 POLICY 7
<br />$
<br />8
<br />AUTOMOBILE
<br />X
<br />LABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />BP9589097
<br />/30/2011
<br />/30/2012
<br />COMBINED SINGLE LIMIT
<br />(Es acode M) $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY (Per accident) S
<br />X
<br />SCHEDULED AUTOS
<br />HIRED ALTOS
<br />PROPERTY DAMAGE $
<br />(Peracraderd)
<br />X
<br />NON-OVM)ED AUTOS
<br />Uninsured motorist combined $ 1 , 000 , 000
<br />Medical payments $ 5,000
<br />UMBRELLA LAB 7KOCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />x
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEDUCTIBLE
<br />$
<br />C
<br />X
<br />I RETENTION $ 0
<br />II8555589
<br />/30/2011
<br />/30/2012
<br />$
<br />D
<br />WORKERS COMPENSATIONX
<br />AND EMPLOYERS' LABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBEREXCLUDED?
<br />(Mandatory In NH)
<br />I.tyes, describe under
<br />NIA
<br />007064808 (CA)
<br />009970163 (MD)
<br />/24/2011
<br />/24 /2011
<br />/24/2012
<br />/24/2012
<br />VAC STATU- OTH-
<br />YLIM17S ER
<br />EL.EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE S 1 000 000
<br />E.L. DISEASE- POLICY LIMIT $ 1 000 1000
<br />DESCRIPTION OF OPERATIONS below
<br />2a
<br />Professional Liability
<br />ISZIL70065111
<br />0/31/2011 0/31/2012
<br />General Aggregate 5,000,000
<br />Deductible: $5,000
<br />Each Occurrence 5,000,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required)
<br />tiE: All Operations
<br />City of Santa Ana, its officers, agents 6 employees are named as additional insured per attached OG -023 01/09
<br />including primary/non-contributory wording 6 GL waiver when required by contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION
<br />INS025 vlaos The ACORD name and logo are registered marks of ACORD
<br />All rights reserved. /
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana—AJ1/
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza 7'�
<br />AUTHORIZED REPRESENrATVE
<br />Santa Ana, CA 92701 :.:i:t �I,[s
<br />'01
<br />Stanley Tutton/CLAUDI
<br />ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION
<br />INS025 vlaos The ACORD name and logo are registered marks of ACORD
<br />All rights reserved. /
<br />
|