COAST LIVE OAK SCHOOL 2 - 2018 - Laserfiche WebLink

Home Browse Search

A�'Ill CERTIFICATE OF LIABILITY INSURANCE DAT22'073DIYVYY) F10 / 8/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Wood Gutmann & Bogart License #0679263 15901 Red Hill Ave., Suite 100 � NAMEACT Robin H _ D11Dway PHONE FAX 4-573-1770 Arc No EXe :714-5 -7 ac Nu: EMAIL ADDREss:nQWgblb.Qom INSURER(S)AFFORDING COVERAGE NAICIf Tustin CA 92780 8 INSURER A -;PHILADELPHIA IND INS CO _ INSURER B: DAMAGE TO RENTED - PREMISES Ea occurrence) '.$100,000 INSURED COAST06 INSURER C, Coast Live Oak School Mark Hay 316 Edgewood Road .. _ _...... __ .. -__ INSURER D: Santa Ana CA 92706 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: 109R9Rft9F7 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRi TYPE OF INSURANCE ADDLSUSR -- _ POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDDIYYYYI (MMIDDIMYI LIMITS A GENERALLIABILITY !..PHPK1080068 /22/2013 /22/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY Iv I - _ DAMAGE TO RENTED - PREMISES Ea occurrence) '.$100,000 MED EXP (Any one person) $5,000 CLAIMS -MADE a OCCUR PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $2,000,000 PRO LOC POLICY JE _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea see dent) ANY AUTO BODILY INJURY (Per person) $. __. ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (Per accident) $- $ UMBRELLA LIAB OCCUR TO EACH OCCURRENCE $ AGGREGATE_. EXCESS ILIAD_ CL APPROVE ryPPy` OVqq E – $ _ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN', ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) N/A SI LISA C1t ASSIStant V rL( Attorney `�/ �J,� ✓ l WC STATU-' OTH-. TORY LIMITS $ $ _ E.L. EACH ACCIDENT_ E.L. DISEASE -EA EM PLOYEE If yyes, describe under ..17i\ l ❑ESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ I i DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Santa Ana, its officers, agents and employees are named as additional insured on the General Liability per attached PI GILD VS 01 08. Cancellation verbiage as per IL0017 11 98 attached. Primary and Non -Contributory applies on the General Liability per attached PI GILD VS 01 08. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED. City of Santa Ana; Parks, Recreation and Community Services Agency Attn: Carmen Acosta 1825 W. Civic Center Drive Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE n 1anR.9nln ArnRn rnRPnRATInlU All Ai hie --—A ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD