|
TRANSPORTATION STUDIES A- 20113 -170 & A- 2015 -013 REVIEWED BY
<br />/ xA
<br />r h'
<br />Accw& CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMM /DD [YYYYI
<br />/1.4/2015
<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 Molder in lieu of such endorsement(s).
<br />PRODUCER
<br />CONTACT Erica Hornaday
<br />The Empire Company
<br />550 North Park Center Drive
<br />PHONE FAX
<br />Af Ne;
<br />E -MAIL
<br />ADDRESS: ettornadayempire. —CO. COm
<br />INSURER S' AFFORDING COVERAGE
<br />NAIL p
<br />Suite 205
<br />INSURERA:CitixenS Insurance Company of
<br />Santa Ana CA 92705
<br />INSURED
<br />INSURER B:Allmerica Financial. Benefit
<br />INSURER C X'assachusetts Bay Insurance Company
<br />$ 300,000
<br />Transportation Studies, Inc.
<br />INSURER D:
<br />$ .. 5,000
<br />2640 Walnut Avenue
<br />..
<br />INSURER: E:
<br />Unit B
<br />INSURER IF
<br />10/1/2015
<br />Tustin CA 92780
<br />■111441na.'IA91=11 . iris' arl7 Eri! 7r711? fntru :la:m'�IF }�,.7M.�r'1M�±7uF_'tt3 - M211,tMLNr.Idl1 'IN II IXIMTMI
<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 NS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS..
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER'
<br />POLICY EFF
<br />MMIDD/YYYY.
<br />POLICY EXP
<br />MMfDDdYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE �.... C3CCUR.
<br />_..
<br />EACH OCCURRENCE
<br />1,000,000
<br />$
<br />DAMAGE T RENTED
<br />PREMISES 1Eaaccurrance
<br />$ 300,000
<br />MED EXP Any One pa,sa)
<br />$ .. 5,000
<br />OB3A71724602
<br />10/1/2015
<br />10/1/2016
<br />PERSONAL$ADV INJURY
<br />$ 1,000,000.
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />X POLICY ❑ FRO- JECT ❑ LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />'.., $ 2,000,000
<br />Empleyee Benefits
<br />'', $ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea a {,,rj nt
<br />$ 1 , 000 , 000
<br />HODILY INJURY iPer person]
<br />$ e.
<br />B
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />AW3A11710502
<br />10/1/2015
<br />10/1/2016
<br />BODILY INJURY (Paoaccid ®mtl
<br />HIRED AUTOS NCN- OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />(P--id-11
<br />S
<br />S
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />a I.,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />OB3A11724802
<br />10/1/2015
<br />10/1/2016
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y f N
<br />ANY PROPRIETOMPARTNERFE.XECUTIiVE
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatary In NHI
<br />K yes, d suoilratn de,
<br />NIA
<br />.3A117244..02
<br />10/1/2015
<br />10/1./201.6
<br />RER OTH.-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 11000,000
<br />E_L. DISEASE - EA EMPLOYE
<br />$ 11000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addifianal Rermarks Schedule may tae att..h d if,,. space is required)
<br />RE: Agreement Numbers A -2013 -170 & A- 2015 -013.
<br />City of Santa Ana is clamed as additional, insured with respect to general liability per form 391 -1006 06
<br />09 attached as required by written contract.
<br />ZKekula @santa- ana.org
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED REPRESENTATIVE
<br />E _ °, a HornLid ay /ERICA �L fAc'"r�t t�R cxr
<br />1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />INS02542m4m)
<br />
|