|
CERTIFICATE OF
<br />LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />4/2$/2015
<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,
<br />EXTEND OR ALTER THE COVERAGE, AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOTES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING ENSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />POLICY NUMBER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the
<br />certificate holder in Ileo of such endorsement(s).
<br />PRODUCER......
<br />NAME:
<br />LAURIE BRENNAN HAUCK
<br />9114 Adams Ave #182
<br />PHONE FAX
<br />IC Ne, Ext: (702) 629-6700 AIC , No): (7 02) 62'9-6701
<br />I.",
<br />ADDSs: brbrenco@aol.com
<br />Huntington Beach, CA 92646
<br />OC98533
<br />IINSUREI AFFORDING COVERAGE I #
<br />INSURER. A'. Burlington T,Ln511ranG:e Company
<br />INSURED Aesco, Inc,.
<br />INSURER 8: The Hartford
<br />17762 Georgetown Lane
<br />MED EXP (Anyone person) $ 5000
<br />INSURER c; Houston Casualty Company
<br />Huntington Beach, Ca 92647
<br />INSURER. D:
<br />INSURER E:
<br />(714) 375-3830
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBERS RFk/lglnN NI IN,Ii
<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 />INSIR
<br />LTR
<br />TYPE OF INSURANCE
<br />AUDL
<br />IiWVD
<br />SUBR
<br />POLICY NUMBER.
<br />(MMIDDlYYYYy
<br />(MMIDDlYYYY)
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE s2,000,000,
<br />p"Urrence) ,._
<br />(Ea100,000..
<br />OENERALLIAt31LITY
<br />COMMERCIALPREMISES
<br />MED EXP (Anyone person) $ 5000
<br />(CLAIMS -MADE CI OCCUR
<br />A
<br />154BW28440
<br />6/24/2014
<br />6/24/20115
<br />PERSONAL /&ADV INJURY s2,000,000.
<br />GENERAL AGGREGATE $2,000,000.
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG s2,000,000.
<br />POLICY PRO- El LOC
<br />JBCT
<br />AUTOMOBILE LIABILITY
<br />Ea accident $ 1,000,000,
<br />BODILY INJURY (Per person) $
<br />ANYAUTO
<br />ALL "WINED SCHEDULED
<br />AUTOS AUTOS,'.
<br />72UECTQ7 770
<br />7/9/2014
<br />7/9/2015
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />EXCE'SSLtlAe
<br />CLAIMS -MADE
<br />AGGREGATE $
<br />DED '.., RI=TENTION $
<br />S
<br />WORKERS COMPENSATION'+
<br />AND EMPLOYERS' LIABILITY YIN
<br />Y .
<br />ANPRO,'RIF.TCJRfRARTNERfEXECIJTq"JF.'
<br />CFFICEWMEIMBER EXCLUDED?
<br />(Mandatory, in NH
<br />NIA
<br />72
<br />7 WWE -I TS7 Q
<br />4/11/2015
<br />4/1.1/201.6
<br />0TH -
<br />kVC YS
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $
<br />1,000,000
<br />Q
<br />F.L. DISEASE- EA EMPLOYEE .5 1,000,000
<br />Ityes, describe hinder
<br />DESCRIPTION OF OPERATIONS beiew
<br />E.L. DISEASE- POLICY LIMITS 1,000,000
<br />C
<br />Professional Liab.
<br />HCC1421080
<br />07/(79/14
<br />07/09/15
<br />$2,000,001 claim
<br />$2,000,000. aggregate
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /'VEHICLES (Allach ACORD 101, Additional Remarks SChedui'e„if morespaceis required)
<br />,h\ E. .I'ff Q...Y v q tl `II iC . �. � 01- - X & F 5 7 V” t'VA �.y` % � IL.�. �_.uj - , t'(T.,,,. . .,...,.m .... ,.. HL.- W .N tl r It.. I R....� N "'r II_. ,Y' t"�I 'y) -:P.... h�,.„N' �'.;......� ..
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana.
<br />Public Works Agency M-22
<br />P.O. Box 1988
<br />Santa. Ana, Calif 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ACORD CORPORATION. All rights rt serv,--ri
<br />ACORD25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
|