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JLEEENG-01 YUENG
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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMNDYYYY)
<br />8!18/2015
<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 License # OE67768
<br />IDA Insurance Services
<br />3875 Ho yard Road
<br />Suite 249
<br />CONTACT Gig! Yuen
<br />PHONE 925) 416-7862 AIC Ho : (925) 416-7869
<br />Ezt
<br />E �ANo
<br />ADDRESS: Glgi.Yuen@ioausa.com
<br />INSURERS) AFFORDING COVERAGE NAIC N
<br />Pleasanton, CA 94588
<br />INSURER A: Travelers Property Casualty Company of America 25674
<br />- - -
<br />INSURED
<br />INSURER B: Argonaut Insurance Company 19801
<br />INSURER C:
<br />JLee Engineering, Inc.
<br />430 S. Garfield Avenue, #301
<br />INSURER D:
<br />INSURER E:
<br />Alhambra, CA 91801 I1\
<br />�VT
<br />„�` -1 1I
<br />INSURER F:
<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 CONTRACTOR 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMIDDI YYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Santa Ana CA 92702
<br />- - -
<br />EACH OCCURRENCE $ 2,000,00
<br />CLAIMS -MADE 1XI OCCUR
<br />88088551,1594
<br />0910112015
<br />0910112016
<br />PREMISES Ea occurrence $ 1,000,00
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL& ADV INJURY $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,00
<br />PRODUCTS - COMP/OP AGG $ 4,000,00
<br />POLICY PRO-
<br />JECT LOC
<br />$
<br />OTHER:
<br />I
<br />I
<br />AUTOMOBILE LIABILITYM
<br />INED SINGLE LIMIT $ 2,000,00
<br />Ea accitlent
<br />BODILY INJURY (Per person) $
<br />A
<br />ANYAUTO
<br />6808855NS94
<br />09101!2015
<br />0910112016
<br />BODILY INJURY (Per accident) $
<br />ALLOWNEO SCHEDULED
<br />X AUTOS AUTOS
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Per accitlent
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DEO I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETONPARTNERIEXECUTIVE YIN
<br />UB329OT632
<br />0910112015
<br />0910112016
<br />OTH-
<br />J( STATUTE ER
<br />E.L. EACH ACCIDENT $ 1.000,00
<br />E.L. DISEASE - EA EMPLOYE9 $ 1,000,00
<br />OFFICEMMEMBER EXCLUDED? ElNIA
<br />(Mandatory In NH)
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab.
<br />IAE1252602
<br />11102/2014
<br />1110212015
<br />Per Claim 1,000,00
<br />B
<br />Professional Liab.
<br />IAE1252602
<br />1110212014
<br />11/0212015
<br />Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 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 PERSON(S) OR ORGANIZATION(S):
<br />City of Santa Ana, its appointed and elected officers, officials, and employees and/or as required per written contract
<br />CERTlnrATE HOLDER CANCELLATION
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1/'
<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
<br />Santa Ana CA 92702
<br />- - -
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 1/'
<br />/
<br />
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