|
ACC)R" OF LIABILITY INSURANCE
<br />DATE (MMIDDYYY)
<br />fYCERTIFICATE
<br />110/26/2016
<br />Il„r,,,•
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<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 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 endorsement(s).
<br />PRODUCER
<br />CONTACT
<br />NAME: Certificates
<br />Rutherfoord A Marsh & McLennan Agency LLC Company
<br />_
<br />PHONE 757-456-0577 l757 466-5296
<br />222 Central Park Avenue
<br />Suite 1340
<br />E-MAIL
<br />ADlO . certificates@ruthertoord.com
<br />INSURER(SIAFFORDUNG COVER AC"E ........
<br />NAIL #
<br />Virginia Beach VA 23462
<br />$1,000,000
<br />INSURER American Zurich Insurance Company – --
<br />-
<br />40142 .
<br />INSURED
<br />INSURER B American Guarantee and LiabilityIn
<br />26247
<br />MuniServices, LLC
<br />INSURER c: North River Insurance Company
<br />21105 _—
<br />Attn: Patricia Dunn Ph# 559'µ271-6852
<br />.....__—
<br />uR frx a American Guarantee and Liability 1n
<br />26247
<br />7625 N. Palm Avenue„ Suite 108
<br />..iN
<br />Fresno CA 93711
<br />INSURERS Indian Harbor Insurance Company w __
<br />36940
<br />INSURER F : Massachusetts Bay Insurance Cam an
<br />22306
<br />COVERAGES CERTIFICATE. NUMBER: 417421056 REVISION NUMBER.'
<br />THIS IS TDCERTIFY 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 DESCRIBEDHEREIN IS 'SUBJECT' TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />TNS
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDLSURR
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />(MM/DDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />CP0982903806
<br />10/3112016
<br />101$112017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE n OCCUR
<br />DAtifAGE"�o''RE�JYE-D
<br />PREMISES Ea, occurrence
<br />.._.....____— .......
<br />$1,000000
<br />MED EXP (Any one person)
<br />510,000
<br />PERSONAL&ADV INJURY
<br />$1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER;
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY PRO-
<br />1:1JECT _.. ... _ LOC
<br />PRODUCTS - COMPIOP AGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />AcomBRIED
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP982902106
<br />10/31/2016
<br />10/31/2017
<br />91l
<br />�Eaaccitlont
<br />$1000,000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ALL OWNED SCHEDULED
<br />OS AUTOS
<br />HIRED AUTOS )( NON-DVvNEQ
<br />AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />$
<br />B
<br />C
<br />X
<br />UMBRELLA LIAB X OCCUR
<br />EXCESS LIAR CLAIMS -MADE
<br />AUC982907906
<br />52280011369
<br />10131/2016
<br />1013112016
<br />10131/2017
<br />10131/2017
<br />EACH OCCURRENCE
<br />– ....---.....
<br />$10,000,000
<br />--............
<br />AGGREGATE
<br />$10,000,000
<br />10,000,000
<br />$Excess
<br />QED I RETENTIONS
<br />D
<br />WORKERS COMPENSATIONY
<br />AND EMPLOYERS' LIABILITY Y f N
<br />ANY PROPRIETORIPARTNERIEXECUTIVE F----1
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />WC982903906
<br />1013112016
<br />10!3112017
<br />X PER OTH-
<br />STATI,7T .....EFj,.. ..
<br />E.. L. EACH ACCIDENT
<br />.
<br />$1,000,000
<br />(Mandatory in NH)F_�'_L.
<br />L. DISEASE - EA EMPLOYE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />..
<br />DISEASE - POLICY LIMIT
<br />$1,000,000
<br />E
<br />F
<br />Professional Llal
<br />Crime
<br />MPP903283601
<br />BDR1035845
<br />10/31/2016
<br />10/3112014
<br />10/31/2017
<br />10/3112017
<br />$5,000,000each claire $5,000,000 Aggre
<br />$5,000,000 Limit $25,000 Ded
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached if more space Is required)
<br />Per the cancellation wording listed on this form, the policy provisions include at least 30 nays notice
<br />of cancellation except for non-payment of premium.
<br />The City of Santa Ana, its agents, officers, servants and employees are named as additional insureds
<br />under the General Liability policy with respect to the operations and work performed by the, named
<br />insured as required by contract.
<br />m,.
<br />City of Santa Ana
<br />Attn: Finance Director
<br />20 Civic Center Plaza
<br />Santa Ana CA 92762-1988 APPROVE
<br />�I ) / /.
<br />rr 1:
<br />CANCELLA
<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 />RIZED REPRESENTATIVE
<br />JL M - C-1
<br />V X71988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered' marks of ACORD
<br />
|