|
.ACbRhPCERTIFICATEF' LIQ 1LITl�(N
<br />DATE(MMIDDIYYYY)
<br />7/31/201.5
<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( es) 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 />The Partners Group Ltd
<br />11225 SE 6th St.
<br />Solite 110
<br />Bellevue WA 98004
<br />NAME CT Laura Dykshoorn
<br />PHONE .. (877) 455-5640 FAICNo): (425)455 6727
<br />E-MDAIL .IDykshoorn@tpgrp.com
<br />INSURERS AFFORDING COVERAGE MAIC #
<br />INSURER A American States Ins Co 1.9704
<br />INSURED
<br />TECHNOLOGY UNLIMITED INC
<br />6802 S 220TH ST
<br />KENT WA 98032 1
<br />INSURERB:G'eneral Ins Co. of America 24732 I,
<br />INSURER C:
<br />INSURER D:
<br />"'.....INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:15-16 GL AL EL XS 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 PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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 />EXCLUSIO'N'S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />!NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADD
<br />B
<br />POLICY NUMBER
<br />MWoB1YYEYY C
<br />MIOw71C7d YEYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />''.. EACH OCCURRENCE $ 1,000,0001
<br />X ..... COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED
<br />PREMISES a occurrence) $ 1,000,000
<br />A
<br />CLAIMS -MADE OCCUR
<br />010126415570
<br />8/4/2015
<br />8/4/2016
<br />M ED EXP (Any one person) $ 10,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />HGEN'L AGGREGATE LIMIT APPLIES PER",
<br />PRODUCTS - COMPIOP AGG S 2,000,000
<br />$
<br />X POLICY PRO- LOC
<br />AUTOMOBILE
<br />LIABILITY
<br />Oi7MBINED SINGLE LIMIT
<br />Ea aecident $ 1,000,000
<br />BODILY INJURY (Per person) S
<br />B
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per accident) '''. $
<br />ALL OWNED SCHEDULED
<br />24CC31262620
<br />8/4/2015
<br />8/4/2016
<br />AUTO'S AUTOS
<br />PROPERTY DAMAGE $
<br />accident
<br />X
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />''(Per
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE. $ 4,000,000
<br />AGGREGATE $ 4,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I xC IRETENTION'S 10,00
<br />$
<br />D1SU41486270
<br />8/4/2015
<br />8/4/2015
<br />A
<br />WORKERS COMPENSATION
<br />WC STAT U- X 0 -
<br />LIMITI TORY ER
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />ANY PROPRCETORIPARTNEWEXECUTIVE
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />OFFICERIMEM8ER EXCLUDED? ❑
<br />(Mandatory In NH)
<br />NIA
<br />O1CI26415570
<br />�B/4/2015
<br />$/4/2016
<br />E.L- DISEASE - EA EMPLOYE.. $ 1,000,000
<br />If yea, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />ashing7•:rrn Stop Ga p
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />The City of Santa Ana, Its officers, agents, volunteers and representatives are primary additional
<br />respect to liability arising out of the operations by or on behalf of the named � nsu d as per attached.
<br />CG 7655 and G7680 T / �p �" � ,'
<br />56 'A P ED
<br />�
<br />d °•vL; d` d �"' G" .�E.'� ' � "'. �,' o-"""' :F- "
<br />F�, .edL
<br />,
<br />(714)647-5304
<br />City of Santa Ana
<br />Attn: Mirella Vargas
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (201 OI105)
<br />INS025 rgninnsl nt
<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 />Lane/LSAVLE
<br />1988-2010 ACORD CORPORATION. Ali rights reserved.
<br />Tha Af't' Pn n=rnn and Innn aro ranicfararl marls of A(r)pn
<br />
|