|
fAC"R!«J CERTIFICATE OF LIABILITY INSURANCE
<br />kI
<br />01 /31MID0IY4
<br />01/31/2014
<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 (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 endorsement(s).
<br />PRODUCER 1- 909 - 243 -8200
<br />CONTACT
<br />NAME: __ •_^�V
<br />Nays of California Insurance Services - Ontario
<br />PHONE w� FAQ X
<br />_IA1G, Ng5M1. 909. -243 -8200 1 IAIC,_Np)1 909 -2fl3 -8201
<br />__.._
<br />Empire Towers IV
<br />EMAIL
<br />ADDRESS:
<br />3800 Conaours, Suite 3400
<br />PRODUCER
<br />Ontario, CA 91764
<br />CUSTOMER 10 p;____..
<br />Kelly Paterson _ _
<br />_. INSURERS AFFORDING COVERAGE NAIL
<br />INSURED
<br />INSURERA: TRANSPORTATION INS CO 20494
<br />clinical Ld OXSCOTieS of San Bernardino, Inc,
<br />INSURERS HARTFORD VISE IN CO 19682
<br />P.O. Box 329
<br />INSURERC CONTSNENTAL OAS CO 20443
<br />San Bernardino, CA 92402
<br />_INSURERO.___
<br />INSURER E:
<br />INSUREPo F
<br />COVERAGES CERTIFICATE NUMBER: 38345821 RFVIAIntd NUMPFR
<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 />INSR 'POOL §lleR _ —_ __— _....
<br />LTR TYPE OF INSURANCE POLICY EFF- POUCYEXP - " "--- -- " - "-
<br />POLICVNIlM9ER MMfDa Y MIODIY LIMITS
<br />A GENERAL LIABILITY C 4034939429 02/01/1 02/01/16
<br />_.__ � 'i EACH YC,CIIRRENCC '$1,000,000
<br />. COMMERCIAL GENERAL LIABILITY I. �Pft[M SC50(ER mcI ePu _,_S 100, ono
<br />CLAIMSMADE X -OCCUR ! MED EXP IAny one person) S 10, DOD
<br />PERSONAL a ADV INJURY $ 1,000,000
<br />_.... _. GENERAL AGGREGATE S 2,000,0 00
<br />- . ---- --
<br />_. —___. _
<br />GFN9. AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGO ; $ 2,000,000
<br />X POLI PRO.
<br />CY LOC $
<br />A AUTOMOBILE LIABILITY '.0 40349394J3 0 115 COMBINED SINGLE LIMIT 51,000,000
<br />ANY AUTO �i'+ (F. Pedde"n
<br />X 4� s
<br />ALL OWNED AUTOS BODILY INJURY IPer Pere ,) S
<br />. ' � � - - - - - --
<br />SGIIGOULEO AUTOS - --
<br />BODILY INJURY (Pa nc a dent) S
<br />' '
<br />PROPCRPf GAMAGC
<br />X HIRED AUTOS �StXaka (PeraeUd.nn S
<br />X ' NoN -oWNEp AUG US .rOSep S
<br />t QUY AttocneY - - - -_
<br />$
<br />A X UMBRELLALIA9 X CUP4034939 / / 02 /ql /1.5EAGH OCCURRENCE i$ 5,000,000
<br />OCCUR 02 O1 19
<br />EXCESS GAS .. -- --- -J" J..
<br />u CLAIMe.M_AU6 AGGREGATE ',, S 5,000,000
<br />.. -_., DEDUCTIGLF ... _ ._._.
<br />. _ ...
<br />X RETENTION 8 0 _ ___._._....
<br />$
<br />AND PLOY RS'LIA TNERICXECUTIVE r— 41WEC @K0213 02 /01/14 02/01/15. X WGBrATB- OTH-
<br />g WORKERS CONIPENSATION
<br />ANY EMPLOYERS' LIABILITY YIN TgHY LIMIT@ ER
<br />OFFICER/MEMBER EXCLUDED? NIA L EACH ACCIDENT S 1,000,000
<br />(Mandatory Id r EL DISEASE � EA EMPLOYEE, S 1 ,000,000
<br />DESCRIPTION OF OPERATIONS belnw EIA;I ASE -POLICY LIMIT 51,000,000
<br />C iPro ena one L ty -- IEEH276179023 - Claims Nd d 03 5
<br />DESCRIPTIONOF OPERATIONS/ LOCATIONS I VEHICLES IAIIACNACOR01p1, Aptliliennl Ramerke 5aM1bduK, If mare apace le rPqulrtdl
<br />Certi Eiaate Holder is named as additional insured an respects
<br />General Liability per form G- 17957 -899 attached.
<br />10 day cancellation for non payment of premium.
<br />City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Dept of Public WOrka ACCORDANCE WITH THE POLICY PROVISIONS.
<br />220 S. Dai9ey Avenue
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92703 c�e_Lt -._-�
<br />USA ,//[j'
<br />ACampoe 0) 1958.2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2008/09) The ACORD name and logo are registered marks of ACORD
<br />38345821
<br />
|