Laserfiche WebLink
�_�r_ C'� _- > <br />.c _ CERTIFICATE OF LIABILITY INSURANCE <br />" <br />oarE /(mml13 l <br />5/820 <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 CERTIFICATEHOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 entiorsement(s). <br />PRODUCER <br />Ambassador Group Inc. <br />7010 E Chauncey Ln <br />Ste 230 <br />Phoenix AZ 85054 <br />CONTACT Laurie Scola <br />NAME: <br />PHONE (480)776-6950 FAX (400)996-fi951 <br />A/C No FynC No <br />E-MAIL lscolatfambassadorins. corn <br />ADDRESS, <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />INSURER A:Continental Casualty Company <br />20443 <br />INSURED ,. olt oJ8 <br />Card Meter Systems Inc. dba CMS Ifi+ <br />7056 Archibald Ave Ste 102-453 <br />Corona CA 92880 <br />INSURERB:Valle Forge Insurance Company <br />20508 <br />INSURERC: <br />INSURER D: <br />INSURER E <br />INSURER F: <br />Knot.Aa:alaIB - rmar_4hill ,111111 yew <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 />INSR <br />LIAR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYVYV <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />g 11000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS-PAAOE �X7 OGGDR <br />4025961553 <br />5/1/2013 <br />5/1/2014 <br />DAMAGET RENTED <br />PREMISES Ea occurrence <br />$ 3001000 <br />MED EXP (Anyone person) <br />$ 10,000 <br />PERSONAL&ADV INJURY <br />$ 11 000,000 <br />_ U <br />GE NERALAGGREGATE <br />$ 2,000,000 <br />GEM, AGGREGATE LIMIT APPLIES PER. <br />POLICY P" X DOC <br />PRODUCTS - COMMOP AGO <br />$ 2,000,000 <br />_ <br />S <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY At <br />ALL OAMED SCHEDULFO <br />Athos AUTOS <br />4025961505 <br />— <br />5/1/2013 <br />.5/1/201.4 <br />COMBINED SINGLE LIMIT <br />Ea accident) <br />BODILY INJURY (Perperson) <br />11000,000 <br />$ <br />X <br />BODILY INJURY (Per accident <br />$ <br />HIRED AUTOS X NON-OWNFC <br />AUTOS <br />P` <br />_) <br />PROPERTY DAMAGE <br />Peraccident <br />$ <br />Uninsured motorist propedy <br />5 <br />_ <br />UMBRELLA LIAB OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LAB_ CLAIMS -MADE <br />DEO RETENTION$ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/ N <br />ANY PROPRIETOR/PARTNER/EXE6UTIVF <br />OFFICERNEMBER EXCLUDED? a <br />(Mandatory in NH) <br />f yes, describe under <br />NIA <br />1025961410 <br />5/1/2013 <br />5/1/2014 <br />WC STATU- OTH- <br />X TO Y LHOTS I ER <br />E.L. EAChi ACCIDENT <br />5 1,000,000 <br />_ <br />E. L. DISEASE - EA EMPLOYEE <br />1,000,000 <br />EL.DISEASE-PULICV LIMIT <br />$ 1, 000, 000 <br />DE SCRIP'rION OF OPERATI ONE below <br />I <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Coverage subject to policy forms, terms and conditions.City of Santa Ana, .its officers, agents and <br />employees and representatives is Named as Additional Insured - Designated Person or Organization. <br />Insurance is primary & non-contributory. APPROV'F�D As TO FORIV1 <br />47 _ <br />City of Santa Ana Parks, Recreation and C <br />Services Agency <br />Attn: Silvia Cuevas 26 Civic Center Plaza <br />Santa Ana, CA 92701 <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 />AUTHORIZED REPRESENTATIVE <br />e Scola/KRE^—a-v-�--- <br />©1988-2010 ACORD CORPORATION. All rights reserved. <br />IN25IQti I9ninrrn or Thu GCr1Rr1 namn and Innn aro ra,ricfarorl marks of Arnran <br />