2-1-1 ORANGE COUNTY - 2014 - Laserfiche WebLink

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211OC -0000 ROQCA1 a►cvt?cX CERTIFICATE OF LIABILITY INSURANCE DAT 612212014 22!2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER LlcenSG # 0564249 Heffernan Insurance Brokers 6 Hutton Centre Drive, Suite 500 Santa Ana, CA 92707 CONTACT NAME: — PHONE FAX ac No Ex :1 714 361.7700 A c No 1 (714 361 -7701 E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# _ INSURER A: Nonprofits Insurance Alliance of California_ 011645 EACH OCCURRENCE INSURED INSURER a:QBE Insurance Corporation 39217 2 -1.1 Orange County 1505 E. 17th Street INSURER C : -_. -- Suite 108 INSURER D: _ INSURER E Santa Ana, CA 92705 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSAUDL LTR R TYPE OFINSURANCE SUSHI POUCYNUMBER POLICYEF O Y X MMIDONYY I fMMIDDNYM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0 OCCUR X 201403104NPO 0210112014 02101/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Eaocccw 500,00 MED EXP (Any one person) _S $ 20,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY El PE� LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMPIOP AGO $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED I SINGLE LIMIT § 1,000,000 A ANY AUTO 201403104NPO 02/01/2014 02/0112015 BODILY INJURY (Per person) ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( I $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ X Xd UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 A --F,—EDT- I EXCESS HAS CLAIMS -MADE _. Q1201403104UMB 0210112014 0210112015 AGGREGATE $ 2,000,00 - .$........ ED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARI 'NER/EXECUTIVE 71 OFFICERIMEMBER EXCLUDED? NIA IPER OTH. STATUTE Eft E.L. EACH ACCIDENT $ (Mandatory in NH) If yes, describe under E.L. DISEASE -EA EMPLOYEE$ I E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Disability- AD &D -Trav Q1201403104ACC 02/01/2014 02101/2015 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be Attached if more space Is required) Re: As Per Contractor Agreement on File with insured. City of Santa Ana, Community Development Agency is name s additional Insured and primaryinon- contributory clause applies to the general liability policy per attached endorsement. TO FORM APP Jt E Jose doval tarn City Attorney City of Santa Ana Community Development Agency. Administrative Services Division M -25 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD