R.B. WELDING INC. 2 - 2012 - Laserfiche WebLink

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A?O/2L7 CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YV•rv> 11l0812D12 THIS CERTIFICATE IS ISSUED AS A 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 ISSVING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER- IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(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 fiolder in lieu of such endorsement(s)- PRODUCER CONTACT k On ark AME- Theo Insurance Services, lnc- PHO?o• F?? .213.380.4040 _ ???o), 213-380-4020 3540 Wilshire Blvd. Ste 1210 E-MAIL k on ark theoins.com J.fOORESS:_-Y?_?Gd LOS Angeles, CA 90010 INSURERS AFFOROIN6 COVERAGE NAIC # __.__.______ wsu?g A- James River Insurance Company __,__ __ INSURED I su E s: State Com ensation Insurance Fund RB Welding, Inc- INSURER c: Mid Century Insurance Com?any__________ _ ? 155 E. Redondo Beach Blvd. su E o - _ Gardena,CA 90248 INSURER E: INSURER F VVVCKALstJ CERTIFICATE NUMBER: REVISION NUMBER= 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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_ INSR TYPE OF INSURANCE ADOL SUBR I I POLICY NUMBER POLICY EFF POLICY EXP I LIMITS GENERAL LIABILITY I I -EACH OCCURRENCE $1DOOOO0 B COMMERCIAL GENERAL LIABILITY ? DAMAGE TO RENTED SE51Fsgccurradce $ 50000 CL41MS-MADE O OCCUR x 00044992-2 0912012012 0912012013 MEO EXP An ane arson s Excluded I PERSONAL 8 ASV INJURY $ 1000OOD x $2i5D0 Deductible GENERAL AGGREGATE _- g200000O GEN'L AGGREGATE LIMIT APPLIES PER' I PRODUCTS -COMP/OP AGG $ 2OD000O X POLICY PRO- LOC ? 15 AUT OMOBILE LW BILITY I COMBINEp SINGLE LIMIT Fe nr+-;den!) i DoD ooD C qNY AUTO BODILY INJURY (Per person) S X ALL OWNED ? SCH FOULED AUTOS AUTOS fiD5D8844r.1 0312712012 03!27!2013 BODILY INJURY (Per accident ) 5 X q?7pSWNED HIRED AUTOS X ; l PRDPERTY DAMAGE ?P_ar_accidenq_-____-? 5 I f VMB RELLA LIAR OCCUR II EACH OCGUF RENCE I $ l EXCESS LIAR CLAIMS-MADE I I AGGREGATE I $ I _ ___ DED RETENTION I g WORKERS COMPENSATION X WC STATU- OTH-I ANO EMPLOYERS' LIABILITY b Y / N ECUTIV? FF / N/A 238 013369 11 E. L. EACH ACCIDENT SiODOOOO O ICER/MEMBER EXCLUDED? (Mandatary In NH) - - 01!01!2012 01!0112013 E.L. DISEASE - EA EMPLOYEE $1 ODOOOO I! yes, describe antler DESC I O OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1 000000 DESCRIPTION OF OPERATONS /LOCATIONS /VEHICLES (Attack ACORD 101, Adtlitlonal Romarks Schedule, If mare epaca is requlretl) The City of Santa Ana, its officers, employees, agents, volunteers and representafives are named as Additional Insureds. Waiver of subrogation applies- -Cancellation clause reverts to 10 days for non-payment of premium- c City of Santa Ana ? Attn_ Purchasing Department 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE AHOVE DESCRIBED POLL CIES BE CANCELLED BEFORE 1})-E EXPIRATON DATE THEREOF, NOTICE WILL BE OEL]V EKED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Attorney AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserve ACORD 25 (201 DlOS) The ACORD name and logo are registered marks of ACORD