|
I %I CERTIFICATE OF LIABILITY INSURANCE
<br />`.. -�'�
<br />D /6 /2/DDlYVVV)
<br />3/6/2013
<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 pollcy(les( 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 endorsamenl a .
<br />PRODUCER
<br />SPIB Insnrance Agency, IAC.
<br />License Number 0719264
<br />26441 Crown Valley Parkway #200
<br />Mission Viejo CA 92691
<br />NAME: Any Alberding
<br />PHONE (949) 5582 -5220 AAC No; t9941Se2 -9512
<br />�_
<br />,amy8spib. com
<br />INSURERS AFFORDING COVERAGE
<br />NAICIt
<br />INSURER A:Peerle59 Insurance Co
<br />24198
<br />INSURED
<br />Rue Vac Property Services Inc
<br />600 W. Taft Avenue
<br />orange CA 92865
<br />INSURERB:The Netherlands Insurance Co
<br />24171
<br />INSURERC:GOlden Eagle Insurance Corp.
<br />0836
<br />INSUREROAtate Comp Insurance Fund
<br />210
<br />INSURERS:
<br />$ 1,000,000
<br />INSURERF:
<br />X COMMERCIAL GENERA. LIABILITY
<br />CLAIMS -MADE 7OCCUR
<br />COVERAGES CERTIFICATENUMBER:314STR 13 -14: INCR.UMB 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR LTR
<br />TYPE OF INSURANCE
<br />A
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICY NUMBER
<br />MMIOI�IYYYY
<br />MMIDOIYYYV
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERA. LIABILITY
<br />CLAIMS -MADE 7OCCUR
<br />/3139558563
<br />/1/2013
<br />/1/2014
<br />PREMISES (Es occuronzol
<br />$ 100,000
<br />MEDEXPtAnymw Parson)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE
<br />UNIT APPLIES
<br />PER.
<br />PRODUCTS- COMP/OPAGG
<br />$ 2,000,000
<br />is POLICY
<br />PRc'T-
<br />LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />Fd oc Nlonl iNGl 6i
<br />1,000,000
<br />BODILY INJURY (Per Tonon)
<br />$
<br />B
<br />PNYAUTOE
<br />TOS ED SCHEDULED
<br />AUTOS
<br />791086
<br />/1/2017
<br />/1/2014
<br />BODILY INJURY IPef accident)
<br />$
<br />X
<br />HIREDAUTOS X N1T0&�ED
<br />pO�nd nj DAMAGE
<br />$
<br />Undenmumd mm ncl rooe
<br />$
<br />X
<br />COMP PER SCH X COLL PER SCH
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />L.
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEO _RET NTION $_
<br />$
<br />09558863
<br />/1/2013
<br />/1 /201-0
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPATNERIDECUINE YIN
<br />OFFICERIMEMBER EXCLUI
<br />(Mandatory In NH)
<br />II SCIesan eundor
<br />DESCRIPTION OF OPERATIONS Wow
<br />NIA
<br />D3II319 -13
<br />/1/2013
<br />/1/2014
<br />X NC SIATU- OTH,
<br />E.L. FACHACCIDENT
<br />$ 1 000 000
<br />EL. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />EL. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />PROPERTY, SPECIAL FORM
<br />DBIPSESS563
<br />/112013
<br />/1/2014
<br />BUILDING 1,248,480
<br />REPL.COST $1000 DED
<br />BUSINESS PEES PROPERTY 104,040
<br />DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If More space is requlredi
<br />A RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA.
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAIAD AS
<br />ADDITIONAL INSUREDS WITH RESPECT TO GENERAi LIABILITY AS PER COMPANY FORM CG2010 07/04 AND CG2037 07/04,
<br />PER WRZTEN CONTRACT PRIMAF I J fS�iT 33U'J03Y1W0R IS PROVIDED IN FORM M 22 -111 01/07.
<br />CERTIFICATE HOLDER Laura Stiff Shcec!4 CANCELLATION
<br />Assistant City Attorney
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />THE CITY OF SANTA ANA
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER PLAZA
<br />AUTHORIZED REPRESENTATIVE
<br />SANTA ANA, CA 92701
<br />c
<br />L Hines, CPCU ARM CLU riMKri +-- rG
<br />ACORD 25 (201D105) O 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />INS025 plows)m The ACORD name and logo are registered marks of ACORD
<br />
|