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ICLEI -2 OP ID: Z8
<br />'► CERTIFICATE OF LIABILITY' INSURANCE
<br />..TE (MMIDDIYYYY)
<br />DA
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />1013112014
<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 DOE'S 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 />CONTACT
<br />NAMC: Kathyillorco
<br />San Francisco P &C
<br />Hays of California Ins Service
<br />PHONE FAac
<br />(alc Na . EXII:650- 393 - 20110' {Arc Nal. .650-
<br />E -M IL
<br />1350 y
<br />Ba shore Hwy, Suite 218
<br />Burlingame, CA 94010
<br />LDDRESSa._.___ _.....
<br />Kathy MoireSco
<br />INISURER(S) AFFORDING C4VE_q?gg NAIL rd
<br />..
<br />INSURER A: Hartford Insurance Com�aanr__
<br />38288
<br />_ ^^.
<br />._.IC�LEI
<br />INSURED USA Inc.
<br />INSURER 13 :
<br />^..
<br />414 13th Street, Suite 400
<br />____
<br />_.._.
<br />Oakland, CA 94612
<br />INSURER C:
<br />''.
<br />_ ...... .. ._
<br />INSURER D:
<br />INSURER E:
<br />...
<br />$
<br />INSURER F u
<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 />ppDl- S%19 POLICY EXP _......,....
<br />LTR TYPE OF INSL9RANCE POLICY NU'h1E�ER gM1l'.N9,TB'DIYYYY' 1MM)DDIYYYY '.... LIMITS
<br />GENERAL LIABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />FACH OCCURRENCE
<br />$
<br />COMMIERCIAL GENERAL LIAMLITY
<br />CLAIMS -MADE OCCUR
<br />DAMAGE C TO RENTED
<br />PREMISES IEa ocrurcence).._
<br />MLD EXP (Any an person)
<br />_..'�... ....— __..._.
<br />$
<br />$
<br />PERSONA & A0V INJURY
<br />$
<br />t; NERAL AGGREGATE
<br />$
<br />GEN'LAGGREGATE LIMIT APPLIES PER
<br />PRODUCTS CCMNOP AGG
<br />$
<br />POLICY PRO LUC
<br />$
<br />AUTOMOBILE LIABILITY
<br />_
<br />COMBINED SINGLE LIMIT
<br />lEaaccidenL-
<br />$
<br />--- ...__v__
<br />BODILY INJURY (Per person)
<br />$ ....... _
<br />ANY AUTO
<br />ALL 014VNED ��. SCHEDULED
<br />AUTOS AUTOS
<br />I3=LY INJURY (Per acdclertl Y
<br />NON -OWNED
<br />HIRFD AUTOS AUFOS
<br />V f2t7F E dTY DAMAGE
<br />PERAcanFNT w.. _...�.._... _.._�.
<br />$
<br />'.. UMBRELLA tJAB
<br />OCCUR
<br />FACHC,CCURRLNCP' .,I
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />I
<br />AGGREGATE
<br />$
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />YIN
<br />ANY PROPRIETORJPARTNERIEXEGUTIVE
<br />OFFICERIMEMBER EXCLUDED? �
<br />(Nlandalocy In NH)
<br />NIA
<br />57WECLX9368
<br />1110112014
<br />1110112015
<br />X WC STATU- 0TH_
<br />TCIRY LIMITS ER
<br />E Im mEACH ACCIDENI
<br />. .......... -- -... -_.
<br />E.L. DISE.ASF, FA EMPLOYEE
<br />.....
<br />$ 1,000,000
<br />-.. -.
<br />$ 1,000,000'
<br />l yos, deacri le tinder
<br />CiMRIPTIONOFO ERATIONSValaw
<br />__ ..�......._
<br />S 1,000,000
<br />..—..
<br />L.L. DISEASE,- POLICYILI>,I•••..1T
<br />i
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCA7DN5 1 VEHICLES (Attach ACORD 141., Additional Remarks Schedule, If more space Is required)
<br />Evidence of coverage for above Insured, 2014 workers compensation policy
<br />renewal. 10 bay's notice of cancellation for nonpaymenet of premium
<br />ICLEI LISA, INC: AGREEMENT # A- 20,13 -193
<br />11
<br />REVIEWED BY: r y, � EUNICE HEREDIUA (pg. 2 Of 2)
<br />CERTIFICATE HOLDER CANCELLATION
<br />0c)1988 -2010 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (20101051) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BF CANCELLED BEFORE
<br />City of Santa Ana (et al)
<br />THE EXPiRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />(see below)
<br />Attn: Christy I'Ci..nc11g
<br />P. D, Box 1988, M -21
<br />Santa Ana, CA 92742
<br />AUTHORIZED REPRESENTATIVE
<br />0c)1988 -2010 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (20101051) The ACORD name and logo are registered marks of ACORD
<br />
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