|
<br />AcoROo CERTIFICATE OF LIABILITY INSURANCE D
<br />/
<br />YVYY)
<br />?.._? 05/29
<br />20
<br />05/29!2012
<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 LICENSE NO. 0637431 CONTACT PATRICK MCRAE
<br />NAME:
<br />PATRICK MCRAE INSURANCE SERVICES PHONE 714) 779-6999 FAX 714 779-6.9.03
<br />(A/C, No, Ext) __ _ _ ____ _JAIC, No) _-(-- - )
<br />1290,'1. 'H1 NCOCK ST., SlUITE 210 E-MAIL
<br />lo
<br />bal.net
<br />ADDRESS_:_ p.mcrae@sbcg
<br />ANAHEIM HILLS
<br />CA 92807 -
<br />-
<br />, INSURERSO AFFORDING COVERAGE NAIC #
<br />i,
<br />- - INSURERA: LIBERTY SUPLUS INSURANCE 10725
<br />INSURED INSURER B: AMERICAN GUARANTEE &LIABILITY INS 26247
<br />CROSSTOWN ELECTRICAL & DATA, INC. - - - - N
<br />INSURER C: CENTURY-NATI NATIONAL INSURANCE CO. 26905
<br />5463 DIAZ STREET
<br />INSURER D: PEERLESS INSURANCE COMPANY 24198
<br />--
<br />
<br />I INSURER E : SCOTTSDALE INSURANCE COMPANY
<br />- - -- 41297
<br />RWINDALE CA 91706 --
<br /> INSURER F
<br />COVERAGES CERTIFICATE NUMBER: Pr:vlclnnl MI IMRFO•
<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 --- OLICY
<br />
<br />ADDL;SU BR -
<br />P EPF POLICY EXP-
<br />LTR TYPE OF INSURANCE
<br />POLICY NUMBER MMlDD/YYVY MM/DDIYYYY LIMITS
<br />A GENERAL LIABILITY 1000008273-02 106/03/2012 06/03/2013 EACH OCCURRENCE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY DEDUCTIBLE:
<br />
<br />$5
<br />000 PER OCC DAMAGE TO RENTED --
<br />
<br />PREMISES fEa occurrence)
<br />100,000
<br />$
<br /> I CLAIMS-MADE ?X? OCCUR , ED
<br /> z _IM
<br />EXP (Any one person) S
<br /> X X-
<br />CU
<br />PLRSONAL & ADV INJURY 1,000,000
<br /> X OCP _ GENERAL AGGREGATE S 2,000,000
<br />
<br />AGGREGATE LIMIT APPLIES PER :
<br />I
<br />PRGDUC S -COMP/OP AGG S 2,000,000
<br /> PRO-
<br />X -
<br />PoucY 1I F _ r-
<br />EBL EA CLAIM/AGG 0 1,000,000
<br />
<br />
<br />C
<br />
<br />i AurortoBILE LIABILITY
<br />
<br />BAP0171987
<br />`
<br />
<br />1/05/ 01.1
<br />s
<br />1
<br />?11J. 51 012
<br />..; ,
<br />
<br />COP
<br />
<br />LI
<br />acvderSINGL SINGLE LIMIT
<br />( e COMBINED 1 000 000
<br /> Y ANY AUTO
<br />
<br />i MPREHENSI?,E DEC
<br />?C
<br />?
<br />
<br />_
<br />BODILY INJURY (Per person) I S
<br /> _
<br />AL
<br />L OWNED X SCHEDULED
<br />$1,000
<br />- -- - - --
<br /> _. AUTOS AUTOS
<br />COLLISION DED BODILY INJURY (Per accident) $ _
<br /> -OWNED
<br />X HIREDAUTOS X NON -OWNED
<br />_- _ AUTOS .
<br />
<br />$1,000
<br />-- -- -
<br />_(Per accidental $
<br /> - S - _
<br />E RAB X OCCUR XLS0082427 06/03/2012 06/03/2013 EACH OCCURRENCE S 1 O
<br />000
<br />OOO
<br /> ES
<br />* CLAIMS-MADE UNDERLYING LIMITS: AGGREGATE ,
<br />,
<br />S 10
<br />000
<br />000
<br /> X O GL; AL; EL POLICIES ,
<br />,
<br /> IEI
<br />RETENTION $ _ S _
<br />B WORKERS COMPENSATION WC966082001 06/03/2012 06/03/2013 STAT - OTH-
<br />X WC
<br /> AND EMPLOYERS' LIABILITY Y / N YR
<br />Q
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ?
<br />NIA
<br />E.L. EACH ACCIDENT
<br />$
<br />1,000,QOO
<br /> (Mandatory in NH)
<br />If yes
<br />describe under E.L. DISEASE - EA EMPLOYEE -
<br />$ 1,000,000
<br /> ,
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000
<br />D BUSINESS OWNERS & CBP 8641920 $752,760 BUILDING
<br /> CONTRACTORS $1,000 DEDUCTIBLE 4/10/201 4/10/201 $367,200 BPP - $300,000 BI WI EE
<br /> EQUIPMENT COV. INCL. THEFT $116,318 SCHEDULED EQ.
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />CITY OF SANTA ANA, ALONG WITH ITS OFFICERS, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL
<br />INSURED AS REQUIRED PER WRITTEN AGREEMENT. INSURANCE BY THE AFFORDED BY THE GENERAL LIABILITY POLICY FOR THE
<br />BENEFIT OF THE ADDITIONAL INSURED IS PRIMARY INSURANCE AS RESPECTS TO ANY CLAIM, LOSS OR LIABLITY CAUSED IN
<br />WHOLE OR IN PART BY THE NAMED INSURED(S) OPERATIONS, AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL
<br />INSURED IS EXCESS AND NON-CONTRIBUTORY. 30 DAY NOTICE OF CANCELLATION IN ANYEVENT.
<br />RE: CITY OF SANTA ANA / TRAFFIC ENGINEERING (CT 1695)
<br />CERTIFICATE HOLDER cAhlr Cl I ATInAI
<br />CITY OF SANTA ANA
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />TRAFFIC ENGINEERING THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLAZA (M-43) ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. BOX 1988 AUTHORIZED REPRESENTATIVE
<br />SANTA ANA, CA 92702
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
|