|
AC-ORjP,, CERTIFICATE OF LIABILITY INSURANCE
<br />01/03/2 13
<br />PRODUCER ' 213, S 53.8400 FAX 213. SS3 , $466
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Wilshire insurance Agency
<br />835 Wilshire Blvd., 4th Floor
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER., THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER T U E COVERAGE AFFORDED BY THE POLICIES BELOW, .
<br />Los Angeles., CA 90017 -2603
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />R I;IOY EXpIRATItlN
<br />mumobno-
<br />INSURERS AFFORDING COVERAGE
<br />NAIL
<br />i 6iEn Un ted Pumping Service, Znc� " -� -
<br />INSURERA. Starr Surplus Lines insurance Co
<br />parry
<br />United Storm Water, Inc.
<br />INSURERS Starr Indemnity & Liability Comp
<br />ny
<br />4 Lease, Inc,
<br />uaunrtol Federal Insurance Company
<br />14000 East Valley Blvd.
<br />INSURER D'
<br />City of Industry, CA 91746
<br />INSURERE�
<br />_1,006
<br />3 0.00
<br />,. .._
<br />,GOVERAGE9
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTW ITHSTANDINGa
<br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
<br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />JULL
<br />501
<br />TYPE Or INSURANCE
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />R I;IOY EXpIRATItlN
<br />mumobno-
<br />LIMITS
<br />OENENALLIAOILIT1'
<br />SLSLLIL72023513
<br />12/31/2012
<br />12/31/2013
<br />EACH OCCURRENCE
<br />$ 00
<br />X COMMERCIAL GENERAL LIAOILITY
<br />DALMGE TORElTiEJ
<br />P3EAi4S,(E;I.w�ecrnl, -_
<br />_1,006
<br />3 0.00
<br />,. .._
<br />I
<br />CLAIMS MADE x 9CCUR
<br />MEOEX}T(Myonape,ron}
<br /># 5,00
<br />A
<br />GERSONALSA4VINJURY ..5
<br />-. — «1 D00,00
<br />_
<br />I
<br />GENERAL AGGREGATE
<br />A 11 O0g , 00
<br />GEN L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP109 AGO
<br />Ii ODD, 00
<br />POLICY FX ..1E DT LcC
<br />••
<br />AUTOMOBILE LIABILITY
<br />SISSPBA08223613
<br />12/31/2011
<br />12/31/2013
<br />111,111111 SINGLE LIMIT
<br />}( ANY AUTO
<br />�
<br />(SO acW-1)
<br />#
<br />1 000,00
<br />ALL OWNED AUTOS
<br />$00FL. INJURY
<br />#
<br />Sc iEDULEO AUTOS I
<br />Ira,
<br />B
<br />—
<br />vY HIRCO AUTOS I
<br />APPROVED
<br />•1+i ('0
<br />: l•t' •. • a
<br />9OCiLY INJURY
<br />S
<br />X NpN OrYNEiY AUTO$
<br />(Pit.e.wenl)
<br />I
<br />x MC5 -sn
<br />GARAGE LIABILITY W._.
<br />Lau
<br />'a , iU
<br />AUTO ONLY � EA ACCIDENT
<br />S
<br />ANYAU1O
<br />Assist
<br />nt City .A"Ort2Y
<br />.. E4 ACO
<br />S
<br />OTHER THAN ._._
<br />AUTO ONLY, AGO
<br />_.. .._._. .�
<br />ExCESWUMURELLA LIABILITY
<br />SLSLXNV73017413jj
<br />12/31/2012
<br />12731/2913
<br />6AGN OCCURRENCE
<br />s9 000,00
<br />I X (OCCUR CLAIMS MME
<br />t
<br />ZOREOATE:
<br />'S 9,QQD, 00
<br />A
<br />i'
<br />GFCUCTS:S
<br />#
<br />X RETENTION 5
<br />III
<br />'NGRKEERSLUPENSATlpkANO
<br />I 0044727244
<br />12/31/20:12
<br />12 /31/2013
<br />wc�TATU per; -.
<br />X .ice -ym„ -s FR
<br />En€PLOYERS LInnlurr
<br />nrar PROPRIETORfii .XCLODk,= XGCIITIVE
<br />EL EACH AODID�r S 1,000,00
<br />D
<br />EI_DISEASE- EAEMPLOYL S 1,000,Og
<br />lowtss non,
<br />If EAO, YAL PR)C ISM(
<br /><PEOIAL PFtvit lS Dr�S�kaluw
<br />@t_ DISEASE, POLICY LIMIT S ]„{}(jQ,tltl
<br />o R _
<br />Rl ution Liability
<br />SLSLE1L72023513
<br />12/31/2012
<br />12/31/2013
<br />$1,000,000 Pollution Limit.
<br />A
<br />Professional Liability
<br />(
<br />C
<br />$1,000,000 Professional. Limit
<br />(Claims Made
<br />$50,000 SIR;11f
<br />$1,000,000 Aggregate
<br />DE5CRIPTION OF OPERATIONS ! LOCATIONS I4'EHICLESI EXCLUSIONS ADDED BY ENDO SEMENT!SPEGIALP OVISIONS —
<br />he City of Santa Ana, it officers, agents, vo unteers an employees are Included as additional
<br />insured, with this insurance primary and non - contributory, as per the attached endorsement form CC 20
<br />7 07 04 and SL 804 (04 -11).
<br />*except 10 days notice of cancellation for non- payment of premium.
<br />CE IPt TE hLOLD)mg CANCELLATION
<br />SHOULD ANY OF 1'HE ABOVE DESCRDIED POLICIES Be CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />City of Santa Ana
<br />`3k_ GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />Public Works Department
<br />OUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE. NO OBLIGATION OR LIABILITY
<br />20 Civic Center Plaza M -36
<br />OF ANY VINO UPON T14F INSURER, ITS OR REPRESENTATIVES.
<br />Santa Ana, CA 92701
<br />/AGENTS
<br />AUTHOmZCO REPRE6T11
<br />} t
<br />N G'AL u t ". DALE' 1
<br />ACORD 25 (4001108) 1 OACORD CORPORATION 1988
<br />
|