WEST COAST STORM, INC. - 2011 - Laserfiche WebLink

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AC40R LY CERTIFICATE OF LIABILITY INSURANCE°",ti;�0";"r' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED ASA 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 DOES 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Risk Transfer Programs, LLC 219 East Livingston Street Orlando, FL 32801 CONTACT NAME: PHONE 866-481-9363 F No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE MAIC N GENERAL LIABILITY INSURER A :CastlePoint National Insurance Company 40134 INSURED Southeast Personnel Leasing, Inc (LCF) West Coast Storm, Inc. 2739 US Highway 19 North Holiday, FL 34691 INSURER 8: INSURER C: INSURER D: INSURER E: INSURER F: %.VlrGnP%%sC0 GF -R1 WICA1 t Nt1M6ER•PAK030M7 0C\/ICIAaI W IaaQCo. 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 BY PAID CLAIMS. MISR LTR TYPE OF INSURANCEPOLICY im Am POLICY NUMBER EFF POLICY EXP LIMn'g SANTA ANA, CA 92702 GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Me occurrence $ MED EXP (Any one person) $ CLAIMS MADE FlOCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO-jECT F-1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS HIRED AUTOS P NON -OWNED PROPERTY $ PPR UMBREis LAB OCCUR EACH OCCURRENCE $ EXCESS EXCESS LL48 CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION WSLTHPE90176901 11/21/2011 06/15/2012 WC STATU- OTH- XLIMITS AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E.L. EACH ACCIDENT $ (Mandatory in NH) I describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below $ $ $ $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Addidonal Remarks Schedule, ff mora space is required) (Californiais to leased employees as approved and assigned by SpyN(t?F st Personnel Leasing,lflc. but tsubrntractors or rations WestCoast ased employees of Store m, Inc. t"" iC' 1��'I This certificate only applies to VARIOUS LOCATIONS IN SANTA ANA, CA. Includes Waiver Of Subrogation in favor of CITY OF SANTA ANA PUBLIC WORKS AGENCY. CFRTIFICATF unl nco rdytt 1 m Z q%J 7566-2070 ACOKU CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD v/9nvGLL/11 Mon SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF SANTA ANA PUBLIC WORKS AGENCY DESIGN ENGINEERING P.O. BOX 19138 M-36 AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92702 rdytt 1 m Z q%J 7566-2070 ACOKU CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD