|
Client#: 1259431 305CORDOCOR
<br />ACORD." CERTIFICATE OF LIABILITY INSURANCE
<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 />IMPpRTANT: 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 fu dorsement(s).
<br />PRODUCER
<br />'NAME"a' Christy Mata
<br />BB&T Insurance Services
<br />PHONE 714 578-7370
<br />Of Orange County
<br />EMAIL _
<br />EMAIL CMata@bbandt.com
<br />nopREss
<br />680 Langsdorf Drive Suite 100
<br />______
<br />Fullerton, CA 92831
<br />...._...__ ...,_._,INSURER(SIAFP(
<br />INSURERA Travelers P ropeFly I
<br />INSURED
<br />Cordoba Corporation
<br />INSURER B
<br />'"" -_-- - ----
<br />1401 N. Broadway
<br />i INSURER c:
<br />Los Angeles, CA 90012.
<br />INSURER D:
<br />COVERAGES CERTIFICATE NUMBER; REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF IN SUIRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORT HE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONOITION OF ANY CONTRACTOR 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 />.,._,_...-.__.__ ...,........_......,_._.__.__ _. .... .__.._._.. ... .._... _._.._.
<br />(NSR TYPE OF INSURANCE ADDL SVBR- - Y N � � POLICY EFF POLIOV EXP v LIMITS
<br />LTR INSR MD POLICY NUMBER MMlODIYYYY :MMIGoIYYYY
<br />A
<br />GENERAL LIABILITY i6306C82815114
<br />1120/2014'01/2012015 EACH OCCURRENCE
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />X COMMERCIAL GENEMLLABLITY
<br />(S1,D_0;-00-00L00000 ...
<br />RAMCA ORENT Dat) 3
<br />_»Jet.LEn.vcwre
<br />._- _
<br />� CLAIMS MAOE �X OCCUR
<br />._..
<br />PIC,
<br />AUTHORIZED REPRESENTATIVE
<br />PED ONALA&ACV INJURY � S5'000
<br />000,000
<br />�I,.GENERAL AGGREGAf 52,000 OOO
<br />ACORD 28 (2010/05) 1 of 1 The ACORD name and
<br />N'L AGGREGATE LIMIT APPLIES PER
<br />:PRODUCTS COMPf)P AGC 32,000000
<br />LXMCN
<br />- ,B
<br />XI. POLICY I - PROT_ LOC
<br />JEC__
<br />S
<br />A
<br />.__ .,.._,.
<br />AUTOMOBILE LIABILITY
<br />! i8106C82815114
<br />COMBINED SINGLE LIMIT
<br />01/2012014i01/20/2015,LEa.1,000,00_0____
<br />ANY AUTO
<br />'-1.
<br />i BODILY INJURY IPe' I a s tj ' $
<br />ALL OWNED SCHEDULED
<br />I 'AUTOS
<br />_BODILY INJURY iPeracr. denglS
<br />AUTOS
<br />NON -OWNED
<br />XHIREU X
<br />PROPERTY DAMAGE __ _ 15
<br />AV 108 -AUTOS 2
<br />_LP IdgQ
<br />S
<br />p UMBRELLA LAB X_ OCCUR CUP6C828151'14
<br />01120/2014101120120151 EACH OCCURRENCE ; s10,000,000
<br />! EXCESS LIAR _. CLAIMS MADE j
<br />_— r._._-
<br />fRETENTIONS_..,....
<br />AGGREGATE G10. 000 OOO
<br />_ . _..
<br />DED.
<br />_
<br />S
<br />A
<br />__._.
<br />woRKeas COMPENSATION .UB6C87099214
<br />—_. —._. .._.___..
<br />01/20/2014!01/201201 5X: WCRYLIMIT ORTn,
<br />EMPLOYERS' LIABILITY YIN
<br />r—
<br />IAND
<br />ANYPROPRIETOWPARTNEREXCUTNE "I
<br />OFFICER/MEMBER EXCLUDED N., N!A
<br />EI EACH ACCIDENT ($1000000, _
<br />4 — -. ---1--
<br />�l�
<br />_e
<br />�,` M rsr toE)
<br />�IlNyae d V J
<br />�+ ~�T �Y�� E.L.DISEASE-EA EMPLOY Ea1 000000
<br />{ S �
<br />S
<br />dasrnt,e W�tler MY. ,i
<br />DESCRIPTION OF OPERATIONS below f 1
<br />1 Fh,_019PA9E-P01.,1f'YIIMIi'$100000_
<br />_.. _..
<br />..._...
<br />LYR, L' 1
<br />DESCRIPTION OP OPERATIONS r LOCATIONS / VEHICLES (Attach ACORO 101, Additional re space la requbed)
<br />Certificate Halder is named as Additional Insured, as respects General Liability, as required by written
<br />Contract per the attached form CGD4140408 pg 1 and 2 of 2.
<br />Additional Insured amended to include the following: The City of Santa Ana, 20 Civic Center Plaza, Santa
<br />Ana, California 92702; its officers, employees, agents and volunteers are named as additional insureds with
<br />regard to liability and defense of suits arising from the operations and uses preformed by or on behalf of
<br />the named insured.
<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 />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702.1988
<br />AUTHORIZED REPRESENTATIVE
<br />©1986-2010 ACORD CORPORATION, All rights reserved.
<br />ACORD 28 (2010/05) 1 of 1 The ACORD name and
<br />logo are registered marks of ACORD
<br />#S116954311M11693570
<br />LXMCN
<br />
|