|
JOSHU-1 OP ID: SW
<br />A` °RO CERTIFICATE OF LIABILITY INSURANCE
<br />1301'YYr''
<br />0 °AT5(MMIDD
<br />05/30112
<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(tes) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the torms 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 />825-866.7050
<br />CONTACT
<br />CCI Financial 8, Ins. Solutions 825.866.8275
<br />License #0381524 PHONE AX No
<br />P. 0. Box 5076 E-NAIL
<br />ADDRESS:
<br />San Ramon, CA 94583-1328
<br />David M. Diamond INSURERS AFFORDING COVERAGE NAIC#
<br /> INSURER A: Peerless Insurance Company
<br />INSURED EHS International, Inc. INSURER B : Golden Eagle Insurance Corp. 10836
<br />26741 Portola Parkway
<br />Suite 1E#823 Preferred Employers Ins. Co.
<br />INSURER C:
<br />10906
<br />Foothill Ranch, CA 92610-1763 INSURER D : Admiral Insurance Company
<br /> INSURER E : -
<br /> INSURER F :
<br />COVERAGES 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />I SR
<br />LTR TYPE OF INSURANCE ADDL SUER POLICYNUMBER POLICY EFF MMIDDY T?
<br />LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
<br />A X COMMERCIAL GENERAL LIABILITY X CBPOS99092 06101112 06101113
<br />DAMAGE TO RENTED
<br />PR
<br />EMISES Eaocarrence
<br />
<br />$ 100,000
<br /> CLAIMS-I.IADE a OCCUR MED EXP (Any one person) $ 5,000
<br /> PERSONAL &ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GENLAGGREGATE LIMITAPPLIES PER: PRODUCTS - COMNOP AGG $ 1,000,000
<br /> X POLICY PRO• LCC $
<br /> AUT OMOBILE LABILITY CEOMB.IN DSINGLELIMIT 1,000,000
<br />A ANYAUTD CBP9599092 06101112 06101113 BODILY INJURY (Per person) $
<br /> ALLOWNED
<br />AUTOS SCHEDULED
<br />AUTOS BODILY INJURY (Per accident) $
<br />
<br />X
<br />X
<br />WNED
<br />PROPERTY E $
<br /> HIRED AUTOS AUTOS accident
<br />
<br /> X UMBRELLAUAB OCCUR
<br />H EACH OCCURRENCE $ 2,000,00
<br />B EXCESS LIAR CLAI?.Q-I.LADE CU8738818 06101112 06101113 AGGREGATE $ 2,000,00
<br /> DED X RETENTION $
<br /> WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY WCSTATU- OTH.
<br />-T RY IMI - R
<br /> YIN
<br />C ANY PROPRIETORIPARTNER/EXECUTIVE
<br />El
<br />NfA KN118028-10 06101112 06101113 E.LEACH ACCIDENT $ 1,000,000
<br /> OFFICE RRSEMBER EXCLUDED?
<br />(Mandatory in NH) E.LDISEASE - EAEMPLOYE $ 1,000,000
<br /> Kyes, descnbe under
<br />DESCRIPTIONOFOPERATIONS below
<br />E.LDISEASE - POLICY LIMIT
<br />s 1,000,000
<br />D Prof Liability E000000145410 02/12/12 02112113 Ea Occur 1,000,000
<br /> Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ii more spa
<br />t@ I
<br />_
<br />The City of Santa Ana, its officers, agents, volunteers and employees are Y
<br />d
<br />Addi
<br />i
<br />l
<br />i
<br />h
<br />l
<br />name
<br />as
<br />t
<br />ona
<br />Insured w
<br />t
<br />respect to General Liability as required by&.V
<br />'
<br />written contract per the attached. Insured
<br />s General Liability coverage is
<br />Primary and Non-Contributory.
<br />CIA
<br />t ?rriCY
<br />N
<br />Oq
<br />ISg?st
<br />Briza Morales
<br />City of Santa Ana
<br />Risk Management, M28
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />CITYSA5
<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 />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
|