Laserfiche WebLink
�— Z,O" /Z- OCo� <br />n�+�or� <br />�""""'" CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM1DOlYYW) <br />06/20/2012 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />DD <br />INSR <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />POLICY NUMBER <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRAC���V1FtrE�1 T}i E,ISSal1A,IG i�(SUi2�R(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER_ - � 1 � 3 <br />PO Y EXP <br />MM/DD/1/`l1rY <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subJect to <br />A <br />the Perms and conditions of the polECy, certain poltclas may require an endorsement. A sta[emr)nt on this certificate does not cbrjfer rights to the <br />certificate holder in lieu of such endorsement(s). � <br />GL885879 <br />PRODUCER <br />Orion Risk Management Insurance Services, Inc. <br />Ca . Li c . #OD28764 <br />2280 Wardlow Circle, Suite 250 <br />Corona, CA 92H8O <br />- - <br />NAME <br />ac NOE:e:951.736.9477 ,,! No;951.736.9478 <br />E -MAIL <br />ADDRESS - <br />RE ET R T <br />PROD ERD 00001183 <br />MED EXP (Any one person) <br />INSURER(S)AFFORDfNO GOVERApE <br />PERSONAL 8 ADV INJURY <br />NAICH <br />INSURED <br />INSURERA_ Golden Eagle 2nsurance Corp. <br />GENERAL AGGREGATE <br />10836 <br />Select Trenchless Pipelines, Inc. <br />INSURERa: Nationwide Ins. Co. <br />$ Z , OOO , OOO <br />25453 <br />DBA: Rooter Alert <br />INSURERC- <br />AUTOMOBILE <br />LWa1L1TY <br />ANY AUTO <br />ALL OWNED AVTOS <br />SGHEDULE❑AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />283 Winfield Circle <br />INSURERD• <br />ACPBA7805038828 <br />ED AS T <br />06/14/2012 <br />� Y <br />v <br />Corona, CA 92880 <br />INSURERE: <br />$ <br />1 OOO . OOO <br />i( <br />INSURER F <br />$ <br />BODILY INJVRY (Per eccJdent) <br />VERAGES CERTIFICATE NUMBER; 12/13 GL /Auto 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 PER]OD <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 lS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />DD <br />INSR <br />SUB <br />WVD <br />POLICY NUMBER <br />L1CY EFF <br />MM/DD <br />PO Y EXP <br />MM/DD/1/`l1rY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAMS- fu1ADE � OCCUR <br />GL885879 <br />Q % /Ui /2012 <br />0 % /O'f /2Uti3 <br />EACH OCCURRENCE <br />$ 1 GOO, OO <br />RE ET R T <br />$ SO OOO <br />MED EXP (Any one person) <br />$ lO , OOO <br />PERSONAL 8 ADV INJURY <br />$ 1 OOO , OO <br />GENERAL AGGREGATE <br />$ Z , OOO OOO <br />GENL AGGREGATE LIhUT APPLIES PER: <br />POLICY X PRO LOC <br />JECT <br />PRODUCTS - COMPlOP AGG <br />$ Z , OOO , OOO <br />$ <br />B <br />AUTOMOBILE <br />LWa1L1TY <br />ANY AUTO <br />ALL OWNED AVTOS <br />SGHEDULE❑AUTOS <br />HIRED AUTOS <br />NON -OWNED AUTOS <br />ACPBA7805038828 <br />ED AS T <br />06/14/2012 <br />� Y <br />v <br />DBh14/2013 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />1 OOO . OOO <br />i( <br />BODILY INIURY(Per person) <br />$ <br />BODILY INJVRY (Per eccJdent) <br />$ <br />PROPERTY DAMAGE <br />(Per aWdant) <br />$ <br />$ <br />VMBRELLA LIAR <br />EXCESS LIAB <br />OCCUR <br />CLAIMS�4IADE <br />, <br />1.871=8 St1tY he <br />/ <br />dy <br />EACH OCCURRENCE <br />5 <br />AGGREGATE <br />$ <br />DEOVCTIBLE <br />RETENTION 5 <br />$ <br />s <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABlLRY Y/ N <br />ANY PROPRIETORIPARTNER/EXECUTNE� <br />OFFICERANEh7BER F�CCLUDED4 <br />(Mandatory In NH) <br />tt Yyes describe under <br />DESGt RIPTION OF OPERATIONS belrnv <br />N / A <br />S 1 <br />WC STATU- TH- <br />T RY <br />EL EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />E. L- DISEASE - POLICY LIMIT <br />-$ <br />DESCRIPTION OF OPERATIONS / LOCATIONS l VEHIC LE8 {Attach ACORD '101, AddlUOnal Remarks Schedule, !/ Toro space Ia required) <br />he City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as <br />dditional insured including completed operations subject to the terms of the attached endorsements. <br />rimary wording applies per the terms of the attached endorsement. 30 days NOC. <br />r,.CK l ll-IGA I C 1-IVLV CK VAfVGCLLA 11VN <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 />City of Santa Ana <br />20 CIVIC Center Plaza �M -30)' AUTHORIZED REPRESENTATIVE y[ C� �� <br />P.O. Hox 1988 V1 LMX <br />Sa to Ana, CA 92702 -1988 La uita Del Pozo LJD <br />©'1888 -2009 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD <br />