|
OP ID: ZG
<br />CERTIFIke, E OF LIABILITY INSU C E °"T09/19/1Y"?''
<br />09119!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 925-934-8500 NACONTACT
<br />ME: =
<br />(WC) Heffernan Insurance Brkrs 925-934-8278 PHONE Fax
<br />1350 Carlback Ave, Suite 200 A!C No Ext No :
<br />Walnut Creek, CA 94596 E-MAIL
<br />OC-HOUSE Commercial-Pre Merg ADDRESS:
<br />CUSTOMER ID eOCPART2
<br />INSURED OC Partnership
<br />Ms. Shawn Kelly
<br />1505 E. 17th St., Suite 108
<br />Santa Ana, CA 92705
<br />INSURER A: NON PROFITS INSURANCE ALLIANCE
<br />INSURER B : MARKEL INSURANCE
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />NAIC #
<br />uvtKAUt:5 CERTIFICATE NUMBER: 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 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 CONDITIONR (-)F RI ICI-I Pr)I Ir.IrC I IAAITC cunXA,ni 1-1 u-- M-1
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE ADDL UBR
<br />POLICY NUMBER
<br />MM DI DIYYYY
<br />MM/DDY/YYYY
<br />LIMITS
<br />
<br />
<br />A GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY X 001111859NPO 09/14/11 09/14112 'AMA E T ENTE
<br />PREMISES F. occurrence
<br />$ 500,000
<br /> CLAIMS-MADE OCCUR MED EXP (Any one person) $ 20,000
<br />
<br /> PERSONAL & ADV INJURY $ 1,000,000
<br />
<br />
<br />' GENERAL AGGREGATE $ 2,000,000
<br /> GEN
<br />L AGGREGATE LIMIT APPLIES PER:
<br />PRO PRODUCTS -COMP/OP AGG $ 2,000,000
<br /> POLICY
<br />LOC $
<br /> AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
<br />A ANY AUTO 201111859NP0 09114/11 09/14112 (Ea accident) $ 1,000,000
<br /> ALL OWNED AUTOS
<br />BODILY INJURY (Per person)
<br />$
<br /> SCHEDULED AUTOS BODILY INJURY (Per accident) $
<br />
<br />X
<br />HIRED AUTOS PROPERTY DAMAGE
<br />P
<br />$
<br /> X (
<br />er accident)
<br /> NON-OWNEDAUTOS $
<br />
<br /> UMBRELLA LIAB
<br />EXCESS LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br />
<br />A CLAIMS-MADE
<br /> 201111859UMBNPO 09114/11 09114!12 AGGREGATE $ 1,000,000
<br />
<br />X DEDUCTIBLE
<br />
<br />WOR RETENTION $ 10,000
<br />KERS COMPENSATION
<br />$
<br />
<br />B AND EMPLOYERS' LIABILITY ?, / N X WC STATT- X OTH-
<br />I ER
<br />
<br />ANY FFICERIMEMBOER/EXCLUDED ECUTIVE r
<br />O
<br />N/A
<br />MW0001228001
<br />09/14111
<br />09/14/12
<br />E.L. EACH ACCIDENT
<br />
<br />$ 1,000,000
<br /> (Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />
<br />
<br />A
<br />flF[f: DESCRIPTION OF OPERATIONS below
<br />
<br />Liquor Liab
<br />RIDTIrI,.I AC l1C?on rnwic . • ..rw r.
<br />
<br />2011011859NPO
<br />
<br />09/14111
<br />
<br />09/14/12 E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />Occ/Agg 1 mm/2mm
<br />Occ/Agg 1mm/lmm
<br />__
<br />- -------- ---•• ••--•-- •.• <,,,erA? arneawe, n more space is required)
<br />,4ect: As on file with the insured
<br />ity of Santa Ana is named as additional insured on General Liability policy
<br />)er attached endorsement CG2026.
<br />,ED R5 S
<br />SANTA19 ,.....??", • ,..,. S? ?13'V
<br />SHOULD ANY OF THE ABOVE DESCRIB { - P CWLI& BEFORE
<br />THE EXPIRATION DATE TH NOTI L B DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISI(WI5
<br />20 Civic Center Plaza M-25
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />©1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
|