Laserfiche WebLink
OP ID: JS <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE 1/125/13 ) <br />11/25/13 <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 />Global Program Managers <br />P.O. Box 7119 <br />Capistrano Beach, CA 92624 <br />Robert Molinaro N_2013 -170 <br />CONTACT Ryan Wood <br />PHONE 626- 943 -2213 FAx 62 <br />A N Ex : AIC No : 5'299'1010 <br />AoMAIIE55: rWOOd @narver.COm <br />PRODUCER <br />CUSTOMER IO, KIDWO -1 <br />INSURERS AFFORDING COVERAGE <br />NAIC p <br />INSURED Kid Works Community Development <br />INSURER A: Philadelphia Indemnity Insuran <br />18058 <br />1902 W. Chestnut Avenue <br />Santa Ana, CA 92703 -4304 <br />INSURER a:Everest National Insurance Co. <br />10120 <br />X <br />PHPK957375 <br />INSURER C <br />01/07/14 <br />INSURER D <br />$ 10,000 <br />one person) <br />INSURER E: <br />n(Anyone <br />ADV INJURY <br />$ 1,000,00 <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 />INSRR <br />TYPE OF INSURANCE <br />DDL <br />R <br />POLICY NUMBER <br />MM /OOY� <br />MMI POLICY <br />LIMITS <br />GENERAL LIABILITY <br />RENCE <br />$ 1,000,00 <br />• <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE A OCCUR <br />X <br />PHPK957375 <br />01107113 <br />01/07/14 <br />accurence <br />$ 10,000 <br />one person) <br />$ 5,00 <br />n(Anyone <br />ADV INJURY <br />$ 1,000,00 <br />REGAT E <br />$ 3,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OMP /OP AGO <br />$ 3,000,00 <br />] JECT X POLICY PRO LOG <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$ 1,000,00 <br />ANY AUTO <br />BODILY INJURY (Per person) <br />IS <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />• <br />X <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />PHPK957375 <br />01/07113 <br />01/07/14 <br />PROPERTY DAMAGE <br />(Per accident) <br />$ <br />• <br />X <br />NON.OWNEDAUTOS <br />PHPK957375 <br />01/07/13 <br />01107114 <br />$ <br />$ <br />X <br />UMBRELLA LIAR <br />1 X <br />OCCUR <br />EACH OCCURRENCE <br />$ 1,000,00 <br />AGGREGATE <br />$ 1,000,00 <br />A <br />EXCESS LAB <br />CLAIMS-MADE <br />PHUB405782 <br />01107/14 <br />01/07/14 <br />DEDUCTIBLE <br />$ <br />$ <br />X <br />RETENTION $ 10,000 <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR /PARTNER/EXECUTIVE YIN <br />OFFICER /MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />NIA <br />5900001267131 <br />02/01113 <br />02 /01 /14 <br />A <br />X WC STATU- OTH- <br />TORYLIMITS ER <br />E.L EACH ACCIDENT <br />IS 1,000,00 <br />E. L. DISEASE - EA EMPLOYE <br />$ 1,000,00 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />`r <br />ASE - POLICY LIMIT <br />$ 1,000,00 <br />A <br />Professional Liab <br />PHPK957375 <br />01107113 <br />OQ. 11 <br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is re <br />RE: Use of City of Santa Ana Parking Lot at 220 S. Daisy Avenue. ✓O� <br />11 The City of Santa Ana, its officers, agents employees and volunteers are 4441I��J10r <br />named as Additional Insured in regards to tie attached General Liability 44t OV <br />Form. Thirty (30) days advance written notice of cancellation. Cjt <br />CERTIFICATE HOLDER CANCELLATION - `ltmk <br />SANTAAN <br />y <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cif of Santa Ana <br />City <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />Robert Molinaro <br />ACORD 25 (2009109) <br />©1988 -2009 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />