|
CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />02125/2013
<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
<br />Aon Risk Services Central, Inc.
<br />Pittsburgh PA office
<br />CONTACT
<br />NAME:
<br />PHONE (g66) 283-7122 FAX (847) 953-5390
<br />(A/C• No• EXt): aCX. No.
<br />Dominion Tower, loth Floor
<br />625 Liberty Avenue
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(5) AFFORDING COVERAGE
<br />NAIC #
<br />Pittsburgh PA 15222-3110 USA
<br />INSURED
<br />INSURER A: Liberty Mutual Fire Ins Co
<br />23035
<br />RBF Consulting
<br />PO Box 57057
<br />INSURER B: Liberty Insurance Corporation
<br />42404
<br />INSURERC: Lloyd's Syndicate No. 2623
<br />AA1128623
<br />Irvine CA 92619-7057 USA
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570049116997 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. Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MWDDIYYYY)
<br />(MMIDDIYYYY1
<br />LIMITS
<br />'4
<br />GENERAL LIABILITY
<br />TB
<br />EACH OCCURRRE ENCE
<br />$2 , OOO, OOO
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X❑ OCCUR
<br />'
<br />DAMA TO NTED
<br />PREMISES Ea occurrence
<br />$1, 000, 000
<br />MED EXP (Any one person)
<br />$ 5 , 000
<br />X Contractual
<br />PPRO T
<br />FORM
<br />PERSONAL & ADV INJURY
<br />$2 , 000, 000
<br />X
<br />BFPD, XCU
<br />GENERALAGGREGATE
<br />$4,000,000
<br />n -)
<br />L Z
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO TrQT X LOC
<br />PRODUCTS - COMPIOP AGG
<br />$4 , 000, 000
<br />A
<br />AUTOMOBILE LIABILITY
<br />As2-6 4 -7 2
<br />COMBINED SINGLE LIMIT
<br />Ea accident)$1,
<br />000, 000
<br />*VAN O. O
<br />E
<br />BODILY INJURY ( Per person)
<br />AUTO
<br />IANY
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />p��nt City At
<br />mey
<br />BODILY INJURY (Per accident)
<br />PROPERTYDAMAGE
<br />Per accident
<br />B
<br />LIAB
<br />OCCUR
<br />TH7681004145682
<br />06/30/2012
<br />06/30/2013
<br />EACH OCCURRENCE
<br />$10,000,000
<br />IUMBRELLA
<br />EXCESS LAB
<br />H
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />DED I RETENTION 410, 000
<br />B
<br />B
<br />WORKERSCOMPENSATION AND
<br />EMPLOYERS'
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE Y 1 N
<br />OFFICER/MEMBEREXCLUDED'
<br />NIA
<br />wA768DO04145692
<br />ADS
<br />WC7681004145702
<br />06/30/2012
<br />06/30/2012
<br />06 30/2013
<br />06/30/2013
<br />X 11. LIMITS ERH
<br />E.L.EACHACCIDENT
<br />$1,000,000
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1, 000, 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />wi
<br />E.L. DISEASE -POLICY LIMIT
<br />$1, 000, 000
<br />C
<br />E&O-PL-Primary
<br />QC1202675
<br />Professional & Pollution
<br />06/30/2012
<br />06/30/2013
<br />Per Claim
<br />Aggregate
<br />$5,000,000
<br />$5,000,000
<br />SIR applies per policy terns
<br />& conditions
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: 301 East Jeannette Lane Residential Project. City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are included as Additional Insured as required by written contract, but limited to the operations of the
<br />Insured under said contract, per the applicable endorsement with respect to the General Liability policy.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE HALL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City of Santa Ana AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701 USA
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />m
<br />r
<br />01
<br />rn
<br />c�
<br />cn
<br />0
<br />N
<br />
|