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SCOTFAZ-01 ROSEM
<br />once (MMronrrYYY)
<br />,.... CERTIFICATE OF LIABILITY INSURANCE 5/30/2014
<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(5), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be ondorsed. 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
<br />INSURED
<br />Suite 900
<br />Scott Fazekas & Associates, Inc.
<br />17777 Dol Paso Drive
<br />Poway, CA 92064
<br />Ulm
<br />COVERAGES CERTIFICATE NUMBER: i„ 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 15 SUBJECT TO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />11N.TR. TYPE OF WSURANCE AUDIINq—p-
<br />Wye POLICY NUMBER
<br />M�tbCYYW 1lydL!i0 YV �--- LIMITS---_�—�
<br />A X I COMMERCIAL GENERAL UAEIUTY
<br />EACH OCCURRENCE $
<br />1,040,00
<br />_ CLAIMS -MADE OCCUR X
<br />PSB0003027
<br />86t8$t2014 0$10$1201$ pREMi5E5 Es nccunencsz
<br />1,000,00
<br />X iiontractual Llab.
<br />MED EXP(Anyone Fawn)
<br />PERSONAL S ADV INJURY $
<br />10,00
<br />1,004,444
<br />i X No Co, owned Autass
<br />I—
<br />I GENT AGGREGATE LIMIT APPLIES PER:
<br />_
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />X PRO. ""
<br />-""-_ ....-.�-
<br />POLICY I 1 JECT LOC
<br />PRODUCTS-COMPIOP AGO, $ _
<br />2,000,000
<br />1 OTHER;
<br />Deductible $
<br />0
<br />LIABILITY
<br />COMBINED SINGLE LIMIT Ea eccidenl $
<br />1,000,000
<br />A ANVAIITp
<br />PSB0003027
<br />........_._....__-.-
<br />OB105I2014 0$(0612015 eoDiLV INJURY (Par person) $
<br />ALL OWNED SCHEDULED
<br />FU,,,OM0IHU1
<br />_
<br />SODILV INJURY
<br />S
<br />AUTOAS
<br />(Per acdtlenlI $
<br />NON -OWNS
<br />HIRED AUTOS AUTOS I
<br />`
<br />((Forced
<br />__
<br />PROPERTY DAMAGE"
<br />t
<br />dent)- 1 $
<br />S
<br />X UMBRELLA❑AB i X OCCUR t
<br />' J
<br />! EACH OCCURRENCE l„$
<br />1,000,00
<br />A EXCESS Lw6 - CLAIMS -MADE!
<br />(PSE0001119
<br />I (
<br />0610512014 `06/0$12015 AGGREGATE s
<br />I i $
<br />1,000,00
<br />DED X RETENTION$ 0`
<br />WORKERSCOMPENSATION
<br />I
<br />I XI PER OTH-
<br />AND EMPLOYERS'LIABILITY
<br />YD
<br />_STATUTE ER
<br />A ONYCERI RIEH RPARrNEXCLUEEO?ECUTIVE
<br />NIA
<br />PSWD001945
<br />D87D6/2094 0$/D5/2D1$ EL EACH ACCIDENT l5
<br />1,644,440
<br />(Mandatory in NIH)
<br />E.DISEASE:EAEMPLOYEE S
<br />1.000,000
<br />It yes, de5aribo under
<br />. DE SC RIPTION OF OPERATIONS below
<br />—'..""'
<br />F.L.DISEASE- PCLICV LIMIT B
<br />1,000,000
<br />B Prof Liab/Clms Made
<br />MCH286352513
<br />l 06106/2014106105/2015 Per Claim
<br />1,000,000
<br />B load.: $20k Per Claim
<br />MCH2$8352513
<br />06/05/2D14 06/06/2015 Aggregate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS (VEHICLES (ACORD 101, Additional Remarks Schedule,
<br />maybe anaehod Samara apace is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, volunteers, representatives and agents are Additional insured's with respect to General Liability per the attached
<br />endorsement as required by written contract.
<br />34 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium In accordance with the policy previsions..
<br />'Ards' V AS TO FORM
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />rU f I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />IN
<br />PYA a HOME
<br />'sttmt
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />A :Ity Attorney
<br />AUTHORIZED REPRESENTATIVE
<br />,
<br />City of Santa Ana �'
<br />20 Ckvtc Center Plaza (M-20)
<br />Santa Ana CA 82742
<br />i.
<br />61966-2014 ACORD CORPORATION. A4 rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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