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<br />tay„�i'�. Fla CERTIFICATE OF LIABILITY INSURANCE
<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 />DATE 21 11 DI14
<br />02121!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($), 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 endorsements),
<br />PRODUCER
<br />Jackson & Jackson Insurance
<br />2220 East Route 66 Star 206
<br />Glendora, CA 91740
<br />Chris E. Vandermeulen
<br />CONTA
<br />kAME: Lori Patterson
<br />_
<br />PHONE F
<br />No E%a: 626. 914 -9944 arc No .026914.1040
<br />_iAiC
<br />E -MAII.
<br />ADDRE,S§,:,
<br />'INSUBER(s) APPpRpIN9 COVERA9E NAIC t{
<br />INSURER_A:Hartford Fire Insurance _ 19662
<br />_
<br />'INSURED 6 Star Elevator Services, Inc, �^
<br />_
<br />INSURER B; National Union Fire of PA 19445
<br />1556 N, Case Street
<br />Orange, CA 82$67
<br />_ _
<br />INSURERC:Preferred Employers 10900
<br />INSURER D: Sentinel Ins. Cc Limited 11000
<br />INSURER E _...
<br />_
<br />PREMISES (E . "L.,$
<br />INSURER FI T_
<br />A
<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 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 />I T
<br />TYPE OR INSURANCE
<br />Santa Ana, CA 92701
<br />THORIIZED REPP�R�E,S�EN�TTATITTIIIVEf
<br />AUTHORIZED
<br />POLICY NUMBER
<br />LIC E F
<br />� 0/Y Y I
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />_
<br />PREMISES (E . "L.,$
<br />_
<br />300,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />�D CLAIMS -MADE FAI OCCUR
<br />X
<br />X
<br />13UENOJ6065
<br />02125/2014
<br />0212512016
<br />MED E %P An ane arson
<br />$ 10,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />a^
<br />GENERAL AGGREGATE
<br />$ 3,000,00
<br />CE42 AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS- COMPIOPAGG
<br />> 3,000,00
<br />$
<br />POLICY X PRO- LOO
<br />AUTOMOBILE LIABILITY
<br />OMBI ED SING E L 1 __
<br />Jggl odtlentl
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />s
<br />D
<br />ANY AUTO
<br />13UENOJ6085
<br />02/25/2014
<br />02125 12016,
<br />BODILY INJURY (For exAdoet)
<br />$
<br />ALLOWNED SCHEDULED
<br />Avr03 AUTOS
<br />NON-OWNED
<br />X HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />tPF.R ACCIDENT?
<br />S
<br />_
<br />$
<br />UMBRELLA L7A8
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,00
<br />_
<br />AGGREGATE
<br />£ 6,000,000
<br />B
<br />X
<br />EXCESS LIAR
<br />CLAIMSWADE
<br />EBU016483148
<br />02/26120140212512015
<br />I PEP I X RF1'EN1'ION$ NIL.
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUUVE Y�
<br />OrF CEMMEMBER EXCUUDEOI
<br />(Mandatory in NR)
<br />NIA
<br />KN144421.3
<br />08/01/2013
<br />08/0112014
<br />A `NCy TATU- OTN•;
<br />E.L. EACH ACCIDENT
<br />-
<br />$ 1,000,000
<br />E.t. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />EL DISEASE - POLNOY LIMIT
<br />1,000,00
<br />Eyes, iesalbe ender
<br />OESCRtPtTON OP OP RATl6Ns belay
<br />k
<br />DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) -
<br />RL: Project 813 -070 - Elevator Maintenance. The City of Santa Ana, 20
<br />Civic Center Plaza, Santa Ana, CA 92703, its officers, employees, agenx'R R.t.)VkL ,
<br />d
<br />volunteers and representatives are named as additional insureds with regar _
<br />Cc 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) y /,_ -.-
<br />_.. - Laura SC.eltuy'_
<br />As3istanL (_ it:Y AI1IWIe
<br />CERTIFICATE HOLDER CANCELLATION
<br />O 1988 -2010 ACORD CORPORATION, All rights reserved,
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cl Of Santa Ana
<br />City
<br />THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M36
<br />Santa Ana, CA 92701
<br />THORIIZED REPP�R�E,S�EN�TTATITTIIIVEf
<br />AUTHORIZED
<br />q�
<br />Z�ff��
<br />O 1988 -2010 ACORD CORPORATION, All rights reserved,
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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