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i JLEEENG-01 YUENG
<br />144Coizo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />��. 912512014
<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 policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />PRODUCER License # OE6776
<br />OA Insurance Services -SF
<br />1875 Hopyard Road, Suite 240
<br />aleasanton. CA 94588
<br />INSURED
<br />JLee Engineering, Inc.
<br />430 S. Garfield Avenue, #301
<br />Alhambra, CA 91801
<br />NNME` Gig! Yuen
<br />PHOFAX
<br />INC No Batt (925) 416-7662 AIC No): (925) 416-7869_ _
<br />ADDRESS: Gigi.Yuen@ioausa.com
<br />_ INSURERISI AFFORDING COVERAGE_ NAIC %
<br />INSURER A: Travelers Property Casualty Company of America 25674
<br />-- _ ___ __. I-
<br />INSURERB: Argonaut Insurance Company 119801
<br />INSURERC
<br />INSURER D
<br />rnvcoA r_ee CPRTIFIne TF NI IMRFR- RFVI81r1N NIIMRFR-
<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 ADDL SUER POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE IMID POUCYNUMBER WMIDDI"YYYY1 MMADDNYYY1 LIMITS
<br />A
<br />x COMMERCIAL GENERAL LABILITY
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />EACH OCCURRENCE
<br />S 2,000,00
<br />'
<br />CLAIMS MADE X� OCCUR
<br />680885SN594
<br />0910112014
<br />09/0112015
<br />DAMAGE TbRENTED
<br />PREMISES Ea occuvence
<br />s 1000,00
<br />MED EXP (Any one person)
<br />S 1 O,OO
<br />_
<br />PERSONAL e ADVINJURY
<br />S 2000,00
<br />GENERALAGGREGATE
<br />GENT AGGREGATE LIM IT APPLI ES PE R.
<br />S 4,000,00
<br />POLICY X PRO- LOC
<br />_ JECTPRO- -_
<br />PRODUCTS AGG
<br />S 4,000,00
<br />_ __.. _
<br />OTHER
<br />S
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />S 2,006,00
<br />--------_
<br />A
<br />ANY AUTO
<br />55 5 4
<br />4'
<br />mon)
<br />BODILY INJURY p
<br />(
<br />$
<br />AUTOS SCHEDULED
<br />BODILY (Per acatlentli$
<br />cd.d
<br />AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />PROPE I $
<br />_
<br />X x MEO
<br />HIREDAUTOS AUTOSNON-O
<br />AUTOS
<br />Per dent) -AGE
<br />demi. _..._ ,
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE I$
<br />AGGREGATE $
<br />EXCESS UAB �LAIM&MADE
<br />DEC RETENTION$
<br />8
<br />RKERS COMPENSATION TION
<br />X
<br />A
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY
<br />UB3290T632
<br />1
<br />09/01/2014 09/0112015 $ 1,898,88
<br />HACCEA
<br />�PLOYEE
<br />CERIMEETOR;PARTNER;E%EcuTlvE
<br />E%CLUOED9 ❑NIA
<br />Mandator, ,oryCO
<br />MandaRr, inN )
<br />' E.L. DISEASE EMPLOYEE $ 1,000,00
<br />fyes descbbe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />E. L. DISEASE - POLICY LIMIT $ 1,000,00
<br />B
<br />Professional Liab.
<br />IIAE1252601
<br />11/02/2013
<br />1110212014 Per Claim 1,000,00
<br />B
<br />Professional Liab.
<br />'IAE1252601
<br />1110212013
<br />11102/2014 Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />All Operations of the Named Insured.
<br />General Liability: See Additional Insured Endorsement attached; such coverage is Primary & Non -Contributory, as required per written contract.
<br />Workers' Compensation: See attached Waiver of Subrogation Endorsement attached. Waiver of Subrogation is in favor of the aformentioned Additional
<br />Insured, as required per Written contract.
<br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSONS) OR ORGANIZATION(S):
<br />City of Santa Ana, its appointed and elected officers, officials, and employees and/or as required per written contract
<br />rcoTlnrATc unl nco CeNCFI I ennN
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />-
<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 />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Planning and Building Agency
<br />20 Civic Center Plaza, M-20�„L;yyr...(,,,�-yr,p.,Y'
<br />Santa Ana CA 92702
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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