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TIBURON, INC. 3C - 2012
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TIBURON, INC. 3C - 2012
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Last modified
2/9/2012 2:52:52 PM
Creation date
2/9/2012 2:52:51 PM
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Contracts
Company Name
TIBURON, INC.
Contract #
N-2009-146-003
Agency
FIRE
Expiration Date
3/14/2013
Insurance Exp Date
9/1/2011
Destruction Year
2018
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A?-O?0® <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYVY) <br />D,/,B/2D,2 <br />?? <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 tR3 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 Ileu of such endorsement(s). <br />PRODUCER <br />i <br />k <br />l CONTACT <br />NAME' <br />Aon R <br />s <br />Insurance SerV <br />Ces WeSL, ZnC. Fi66 <br />283 <br />LOS Angel e5 CA Offi ce J <br />-]122 AlC Nc (847) 953-5390 <br />AIC ?NO. E%t); ( <br />707 Wi l shi re Boulevard E?IIAIL <br />Suite 2600 ADDResH: <br />Los Angeles CA 90017-0460 USA <br /> INSURER(S) AFFORDING COVERAGE NAIC p <br />INHURED INSVRER A: Federal insurance Company 20281 <br />Tl boron, InC. INHURER B: Great NOrLhern Insurance co. 20303 <br />6200 5toneridge Nall <br />Pl eaSanLOn CA 94588 USA INSVRER C: PdCli`lC Indemni Ly CO 20346 <br /> INSURER O: Conti nenLal Casualty Company 20443 <br /> INSVRER E: <br /> INHURER F- <br />COVERAGES CERTIFICATE NUMBER: 570045'137'166 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. Limits Shown are as requested <br />LTR TYPE OF INSURANCE INSR VN/D POLICY NUMBER MMIOD/`IYYY MRVDD/YYYY LIMIT S <br /> BENERAL LIABILITY EACH OCCURRENCE $1, 000 , 000 <br /> X COMMERCIAL GENERAL LIABILITY PREMISES Ea occunance $l, 000' 000 <br /> CLAIMS-MADE X? OGGUR MED EXP (Any one parson) $lO, 000 <br /> PERSONAL6ADV 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 /> POLICY X PRO- X LOC <br />B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br />t <br />$1,000,000 <br /> X ANY AUTO BODILY INJURY (Per person) <br /> ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS BODILY INJURY (Per eccltlenl) <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS Per ecuden\ <br /> <br />D % UMBRELLA LWB X OCCUR L4030957581 09/01/2011 09/01 2012 EAGM OGGV RRENGE $10,000,000 <br /> E%CE33 LIAR CV+,IMS-MADE AGGREGATE $10,000,000 <br /> DED RETENTION ?{ <br />C WORKERS COMPENSATION AND 7 7 7 7 ? O 1 1 0 Ol O WC STATU- OTH- <br />X <br /> EMPLOYERS' LIABILITY <br />• TORY LIMITS <br /> / N <br />T <br />ANY PROPRIETOR /PARTNER /EXECUTIVE ? <br />OFFICER/MEMBER EXCLUDED'! Y <br />N / A App E.L. EACH ACCIDENT $1 r 000 r 000 <br /> <br />(Mandatory In NH) _ <br />/ / <br /> <br />? ? <br />E.L. DISEASE-EA EMPLOYEE <br />$1, 000 , 000 <br /> 11 ef, tleacrlbe untlaf <br />DESCRIPTION OF OPERATIONS below <br /> <br />, <br />f <br />E.L. DISEASE-POLICY LIMIT <br />$1, 000 , 000 <br /> d <br /> . CR HWAIT <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHCLES (AtYCM1 AGORD Ad?a{JiMBaI?iaObs?WYa?fCa If rsqulratl) <br />d <br />w <br />c <br />d <br />9 <br />-?O <br />0 <br />2 <br />tO <br />b <br />r <br />n) <br />0 <br />Z <br />?q <br />U <br />4_ <br />i'u <br /> <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City Of Santa Ana AUTIiORIZED REPRESENTATIVE <br />Attn: Lori Smith <br />20 Civic Center Plaza A? ?r ?? ?i??a ? ?? <br />Santa Ana CA 92701 u5A t(WYP/ ??G4tsbCd, <br />©'1986-20'10 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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