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5STAR -1 OP Ifs: LP
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (M'duIDDiYYYY) ...
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
<br />0712212016
<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(ies) must be endorsed, If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the p'ol'icy, 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 />wAMI : r Lori Patterson
<br />Jackson & Ja'.cksonInsurance
<br />302 E Foothill Bivd
<br />-PHGNe m .............. .. . . .- PAx ..�..m ........
<br />Ac.t+® 625- 914 -9944 arc No:625- 914 -9040
<br />_ "
<br />E -MAIL
<br />ADDRESS:.
<br />San Dimas, CA 91773
<br />Lori Patterson
<br />EAOFIOCOURRENCE
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIO 4
<br />INSURER A:. Hartford Fire Insurance
<br />1.9682
<br />X
<br />INSURED 5 Star Elevator Service, Inc.
<br />INSURERS National Union Fire of PA
<br />19445
<br />1556 N. Case Street
<br />__.._... _
<br />INSURER C; Preferred Employers
<br />10900
<br />Orange, CA 82867
<br />INSURERDJrurribull.Insurance Company
<br />...27120
<br />INSURER 2:
<br />..
<br />INSURER. F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE IPOLICIES OF INSURANCE L18TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWVTH!STANDING ANY RIFQUIRFMENT, 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 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR
<br />LTR
<br />TYPE OfINSURANCI;
<br />ADD
<br />INSO
<br />WVD
<br />- _- _.....
<br />POLICY NUMBER
<br />0611CY FrF
<br />(MMIDD,rYYYY
<br />POLICY EXP
<br />'TdMIDDIYYYY
<br />( _._.........._
<br />( LIMITS
<br />A
<br />X
<br />GOMMERCIALGE.NERALLIA ®ILP.'TY
<br />EAOFIOCOURRENCE
<br />$ 1,000,000
<br />CLAIM MACE 7x cccuR
<br />X
<br />X
<br />13UENOJ6085
<br />02/251 2016
<br />0212 x12016
<br />PREMISE SE a uccu trice
<br />s 300,000
<br />MED EXP (Any one parson)
<br />$ 10,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />_
<br />AGGREGATE LUMIT APPLIES PER "
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L
<br />POLICY 1 -" E'CY ❑ LOC
<br />PRODiUCTS - COMPIOPAGG
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Pd pccldentj
<br />$: 1 .0'00 000
<br />_.
<br />BODILY INJURY (Her Per5017) .
<br />-..r
<br />$
<br />D
<br />ANY AUTO
<br />13UENOJ6085
<br />0212512015'
<br />02125/2016
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />"..._
<br />BODILY INJURY (Per accldent),$
<br />- ...._ "_-.
<br />NiON -OWNED
<br />" HIRED AUTOS AUTOS
<br />PRCSPERTY DAMAGE
<br />F"eraceldent
<br />$
<br />UMBRELLA LIAR " ` OCCUR
<br />�
<br />EACH OCCURRENCE.
<br />$ ...... 9,000,000
<br />E
<br />T
<br />EXCESS LAB CLAIMS -MADE
<br />I
<br />EBU060293123
<br />02125/2015
<br />0212512016
<br />AGGREGATE ''
<br />GProdlOpS
<br />$ 9,000,000
<br />_.
<br />Den X RFTENTIOIU$ NIL
<br />$ 9,000,000
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y N
<br />ANY PROPRIETORWARTNERIEXECUTIVE
<br />OFFICERRYIEMBER EXCLUDED? FT
<br />{Ma,ndatory In NH)
<br />N d A
<br />WKN144421 -5
<br />09101/2015
<br />0810112016
<br />X SEATUTE ORTH»
<br />EL EACH ACCIDENT
<br />E.L. DISEASE -CA F.MPLOYLE
<br />$ 1,000,000
<br />--
<br />$ 1,000,000
<br />If Yes, describe under
<br />DESCRIPTION OF OPERATIONS holow
<br />E.L, DISHASH - POLICY I..IM.rf
<br />I $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LO'CATION'S 1 VEHICLES QACORD 10, Additional Remarks Schedule, may be adached if more space is regWred)
<br />RE: Project #13 -070' _ Elevator Maintenance. The City of Santa Ana, 20
<br />Civic Center Plaza„ Santa Ana, CA 92701; its officers, employees, agents,
<br />volunteers and representatives are named as additional insureds with regard
<br />to general liability and defense of suits arising from the operations and
<br />uses performed by or on behalf of the named insured, per attached (over)
<br />CERTIFICATE HOLDER CANCELLATION
<br />Q 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (20'14101) The ACORD name and logo are registered onarks �,'7- 5 ST AR ELEVATOR SERVICE A- 2013 - 166 -C2 ` C REREVIEWED BY: l /, . EUNIC,E H Rf DIA (PG °I OF 2)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC Center Plaza, M -36
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Q 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (20'14101) The ACORD name and logo are registered onarks �,'7- 5 ST AR ELEVATOR SERVICE A- 2013 - 166 -C2 ` C REREVIEWED BY: l /, . EUNIC,E H Rf DIA (PG °I OF 2)
<br />
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