|
178504 Servando Varela dba XV Solutions Certificate of Insurance
<br />2 o I -i 112 -
<br />(page
<br />1 ..(page 1 of 1) 10130/2013 12:07:23 PM
<br />CERTICERTIFICATE OF LIABILITY INSURANCEDATE30/20n'YYYj
<br />FICATE�,,..,.
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF 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 />1013Q/2D13
<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 DOE'S 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
<br />CONTACT
<br />NAME:
<br />�a1Nc no ExW (300) 668-7020 FAX No: (877) 826-9067
<br />Techlnsurance
<br />000 '1301 Central Expy, South, Suite 115
<br />Tech Insurance
<br />a'DDRESS:
<br />'�0:
<br />PRODUCER
<br />Allen, TX 75013
<br />.CUS70MERID#7
<br />INSURER(S) AFFORDING COVERAGE
<br />MAIC N..
<br />. INSURED
<br />INSURER A . The Hartford
<br />30104
<br />INSURER. B:.
<br />Servando Varela dba XV Solutions
<br />344 Orange Blossom
<br />INSURER C
<br />PERSONAL & ADV INJURY
<br />Irvine, CA 92618
<br />A
<br />Yes
<br />INSURER 0:
<br />465BMUV8485
<br />912812013
<br />INSURER E
<br />INSURER F:
<br />GENERAL AGGREGATE
<br />S 4,000,000
<br />COVERAGES CERTIFICATE NUMBER: 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 CONDITIONOF 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 ADDL SUBR POLICY EFF POLICY EXP
<br />(
<br />LTR TYPE of INSURANCE, WVDPOLICY NUMBER MMIDDNYYY MM/DD/YYYY LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 2,000,000
<br />J COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TOE RENr)
<br />PREMISE6 Ea occurTErence
<br />$ 300,000
<br />CLAIMS -MADE. IV] OCCUR
<br />MEI] EXP (Any one person)
<br />S 10,000
<br />PERSONAL & ADV INJURY
<br />S Z000,00U
<br />A
<br />Yes
<br />465BMUV8485
<br />912812013
<br />912512014
<br />GENERAL AGGREGATE
<br />S 4,000,000
<br />GEN1 AGGREGATE LIMIT APPLIES PE;R,
<br />PRODUCTS - COMP/OP AGO,
<br />5 4.000,000
<br />POLICY PRD LOC
<br />._.._....
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT (Eaaccident)ANY
<br />rs
<br />AUTO
<br />..............BODILY INJURY (Per person}ALL
<br />OWNED AUTOS
<br />BODILY INJURY (Per accident]
<br />SCHEDULED AUTOS1-'""`�"
<br />HIRED AUTOS
<br />PROPERTY' DAMAGE
<br />Per acoldem)
<br />$
<br />_
<br />5
<br />NON -OWNED AUTOS
<br />..._..._..,...... _.... _................... .........-.�........
<br />5
<br />UMBRELLA LIAB
<br />I OCCUR
<br />,
<br />EACH OCCURRENCE
<br />5
<br />EXCESS LIAB
<br />'... CLAIMS -MADE
<br />AGGREGATE
<br />S
<br />DEDUCTIBLE
<br />5
<br />S
<br />RETENTION S
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />I ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />—TOI
<br />ANY PROPRIETORIPARTNEWEXECUTI'VF
<br />E.L. EACH ACCIDENT S
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />....... ---....--..-.---- .--_.—
<br />[Mandatoryr "NH)
<br />E L DISEASE - EA EMPLOYEE S
<br />PI yes, describe under
<br />DESCRIPTION OF OPERATIONS Below
<br />._-._ww�.___.,�,..._....,.._..__...._....._,_....
<br />E L DISEASE - POLICY LIMIT S
<br />i
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101,. Additional Remarks Schedule, if more space is required)
<br />Operations pertaining to named Inured for certholder, City of Santa Ana and Its officers, agents, representatives, volunteers, & employees are additional Insured 1
<br />prim wrd as respects gen'l liab per end'ts CG7158 12103&CG7253 9105'30 day Should any of the above described policies be cancelled before the expiration
<br />date, the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non-payment) to the certificate holder named below, but failure to do
<br />so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
<br />A'
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana. CA 92.701
<br />ACORD 25 (2809109)
<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 />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|