|
A � ds CERTIFICATE OF LI LIABILITY INSURANCE
<br />DATE (MMIDOfRHY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />G7t0812014
<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($), 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 endorsoment(s).
<br />PRODUCER
<br />MARSH USA, INC,
<br />CONTACT
<br />AMA: .____
<br />445 SOUTH STREET
<br />PHONE-- xh:..__._.._.._
<br />MORPoSTOWN, NJ 079606454
<br />E- MAIL
<br />Alm Mra istawncenraquest@marshCom Fax 212 - 9469979
<br />-- _d T—
<br />- - - - -- - - - - -- -
<br />�t
<br />1 F7 PROT I X I
<br />INSURER(SLAFFORDINGCGVERAGE NAICK
<br />123456 -GAW -1374
<br />INSURER A; DrOn American Insurance Co '16586
<br />INSURED
<br />York Insurance Acquisition, LLC
<br />INSURER B .__
<br />and its Subsidiaries
<br />INSURER 0:
<br />99 Cherry Hill Road, Suite 102
<br />_
<br />Company, NJ 07054 -1102
<br />msuRSR o
<br />—
<br />NSURER E:
<br />UMBRELLA UAD OCCUR
<br />INSURER F ;
<br />CUVEKAGE5 CERTIFICATE NUMBER: NYC-006896682.01 RFVI.SInN NIIMHFR•Y
<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 />INBR{ TYPE OF INSURANCE ,AOOLISIT9R_ POLICY NUMBER MMILDI6Y MMIDCY1 LIMITS
<br />A I GENERAL LIABILITY I jCP05820234-00 11211512018 1211512014
<br />1
<br />}-.- -I
<br />T 4,090,000
<br />` OCCURRENCE �S_
<br />I
<br />X I COMMERCIAL GENERAL LIABILITY
<br />-PAGH _
<br />DA A Y6k Y 0 1,900,
<br />AUTHORIZED REPRESENTATIVE
<br />EMISES IEa occurzared
<br />CLAIMS-MADE �X r OCCUR
<br />Ir ME-D EXP Any are person) ' $ 5,000
<br />_
<br />PERSONAL &AOV INJURY j g 1,000,000
<br />II-- _____
<br />I,bEN'L
<br />k GENERAL AGGREGATE j S 2,000,000
<br />AGGREGATE LIMIT APPLIES PER
<br />`PRODUCTS - COMPIOP AGO 2,000,000
<br />�t
<br />1 F7 PROT I X I
<br />POLICY LOG 1
<br />S
<br />_
<br />A . AUTOMOBILE LIABILITY :BAP 5820233 -00 112I15F2013 t72}f5/20iq
<br />MINED SINGLE LIMIT 1,00 0,000_
<br />aentl l
<br />- .....�
<br />X ANY AUTO
<br />Lp acs g ____
<br />BODILY INJURY (Perperson) S
<br />lALLOWNCD 77 SCHEDULED
<br />AUTOS AUTOS
<br />-�
<br />_I
<br />BODILY INJURY (Per acgaent)_'S
<br />NON-ONMED
<br />OS I
<br />HRED.AUT '
<br />'-; �IAUTO5 {
<br />R PEf2TY DAMA73E
<br />t(PeY aesiaenD `S
<br />t S
<br />UMBRELLA UAD OCCUR
<br />'EAC{OCCURRENE,'E IS
<br />:EXCESS LIAR
<br />.m C LAMS.MADFI
<br />•
<br />AGGREGATE '; $
<br />1 DED RETENTIONS
<br />6
<br />A 1 WORKERS COMPENSATION WC 6820235-00 11211512013 12115 014
<br />X I AID STATUL 1 0TH
<br />AND EMPLOYERS' LIABILITY YIN
<br />TOBY_r.JMLTSI ER
<br />ANY PROPRIETORIPARTNBRIEXECUTNE :
<br />-O FFICERM,EMBER[DtL I N/A
<br />EL.'eACHAGCIDEN 1S 1,000,090
<br />(Mandatory In NH)
<br />DISEASE -EA EMPLOY E�F g 1,000,000
<br />IA
<br />C, describe under
<br />' D�SCRIPPON OF OPERATIONS below
<br />E— —
<br />I E1, DISEASE POLICY LIMIT I S 1,600,090
<br />W
<br />II i
<br />I I
<br />i
<br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is mquiredl
<br />The City of Santa Ana, its OHoer$, employees, agents, and representatives am Included se additional Insured (except workers compensation) where
<br />required by writer Contract.
<br />ASS P©FtM
<br />APPROVED -
<br />L,L.
<br />sTORCK
<br />i E. ,
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />City Of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Alto: PUrchasing Department
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza, P.O. Box 19881M-16
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />of March USA Inn.
<br />Manashi Mukherjee .AvCman. sii r 4.w„Ltn,a..a.e:..
<br />O 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
|