Laserfiche WebLink
OP ID: PC <br />' 'c"RLY C E RTI F IL :TE OF LIABILITY I NS U R. �4 C E <br />DATE/YYYY) <br />09/301/30/11 <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(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 endorsement(s). <br />PRODUCER 626-405-8031 <br />Chapman 626-405-0585 <br />License #0522024 <br />P. O. Box 5455 <br />Pasadena, CA 91117-0455 <br />CONTACT <br />NAME: <br />PHONE <br />(A/C, No xt): Arc No): <br />ADDRESS: <br />PRODUCER INTER-5 <br />CUSTOMER ID #: <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURED Interval House <br />P.O. Box 3356 <br />Seal Beach, CA 90740 <br />INSURERA: Riverport Insurance Company <br />36684 <br />INSURER B: Everest National <br />10120 <br />INSURER C <br />INSURER D : <br />INSURER E : <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION NIIMRER- <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 />LT72 <br />TYPE OF INSURANCE <br />ADDL <br />IN <br />SUBR <br />WV <br />POLICY NUMBER <br />POLICY EFF <br />MM/DD/YYYY <br />POLICY-EXP <br />I MM/DDfYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />X <br />RIC0012016 <br />10/01/11 <br />10/01/12 <br />PREMISES Eaoccu ante <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />X Professional Liab <br />PERSONAL & ADV INJURY <br />$ 1,000,000 <br />X <br />Sexual Abuse Liab <br />GENERALAGGREGATE <br />I $ 3,000,000 <br />y� ��vv <br />V D AS <br />PR <br />((�� <br />TO F® <br />(�/j <br />s•y _ <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />PRODUCTS- COMP/OP AGG <br />$ 3,000,000 <br />POLICY PE° Loc <br />/'- <br />ProfLiab <br />$ 1mil/3mil <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNEDAUTOS <br />- ` <br />®�, S <br />LISA } <br />Cit. <br />_ <br />ORCK <br />Attorney <br />1 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ <br />BODILYINJURY(Perperson) <br />$ <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />I $ <br />Is <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE I <br />$ 2,000,000 <br />A <br />X <br />EXCESS LIAB <br />CLAIMS -MADE <br />REL0012017 <br />10101l11 <br />10/01/12 <br />AGGREGATE <br />$ 2,000,000 <br />DEDUCTIBLE <br />$ <br />X <br />RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLO ERS' LIABILIITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/M EMBER EXCLUDED? ❑ <br />N/A <br />6600000287111 <br />02/01/11 <br />02/01/12 <br />X ORY LAMITS X OER <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />E.L. DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />(Mandatoryin NH) <br />If yes, describe under <br />DES CRIPTIONOFOPERATIONS below <br />E.L. DISEASE-POLICYLIMIT I <br />$ 1,000,000 <br />A <br />Property Coverage <br />RIC0012016 <br />10/01/11 <br />10/01/12 <br />Blkt Cont 426,000 <br />A <br />Crime Coverage <br />RIC0012016 <br />10/01/11 <br />10/01/12 <br />Empl Dish 200,000 <br />DESCRIPTION OF OPERATIONS r LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) <br />Re: Contract #A-2010-061-002; A-2009-133; A-2009-133A. City of Santa Ana, <br />its officers, employees, agents, volunteers and representatives are named <br />additional insured with respect to the General Liability policy of the named <br />insured - CG 2026 endorsement to follow. Such insurance is primary and <br />non-contributo per the attached endorsement. Workers Com ensation Contd. <br />CERTIFICATE HOLDER <br />CITY016 <br />City of Santa Ana <br />Community Dev. Agency (M-25) <br />Attn: Frank Hernandez <br />20 Civic Center Plaza, M-25 <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 />©1988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD <br />