|
/r^�^'_
<br />✓f1.044 y HOU'S&HA-01 KGOAD
<br />_,AC: . iJ.m. RATE (MM(DD YYYY)
<br />� CERTIFICATE LIABILITY INSURANCE
<br />THIS CERTIFICATE, IS IIS'SUED 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 IN'SURER(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 # OC36861
<br />O
<br />NAAME CT Stacy Guillen
<br />Inland Empire-Allllant Insurance Services, Inc.
<br />PHONE 909 886-9861 FAX 909 886-2013
<br />(AIC, No, Ext): ( ) [A1C, No): ( )
<br />735 Carnegie Dr Ste 200
<br />E-MAIL
<br />San Bernardino, CA 92408
<br />ADDRESS:
<br />DAMAGE TO RENTED50
<br />PREMISES (Ea occurrence) S_
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />_.
<br />IINSURERA:lronshore Specialty Insurance Co 25445
<br />_INSURER
<br />...INSURER
<br />13:ALLIED P & C Ins Co 42579
<br />Houston & Harris PC S Inc
<br />INSURER C : RSUI Indemnity Company 22314
<br />21831 Barton Road
<br />INSURER D: State Compensation Insurance Fund of CA 35076
<br />Grand Terrace, CA 92313
<br />INSURER E
<br />PRODUCTS - COMPIOP AGG $
<br />........ ........ .__.
<br />INSURER, F' : .I
<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
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE. ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />IMSIR TYPE OF INSURANCE AODL SUBR. ..POLICY EFF POLICY EXP
<br />LTR INSD WVD POLICY NUMBER (MM=tYYYY) (MMIDDMYYY)
<br />......LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE S
<br />1,000,000
<br />.. CLAIMS -MACE X OCCUR X ASGO027603 0612412015 06/24/2016
<br />DAMAGE TO RENTED50
<br />PREMISES (Ea occurrence) S_
<br />000
<br />'
<br />MED EXP (Any one person) $
<br />5,000
<br />PERSONAL & ADV INJURY $
<br />1,000,000
<br />GE:N'L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE $..
<br />2,000,00.0
<br />...... ..'X.... E
<br />_.._ POLICY CT ., LOC
<br />._.....
<br />PRODUCTS - COMPIOP AGG $
<br />........ ........ .__.
<br />2,000,000
<br />......... ...
<br />OTHER...._.........
<br />S..
<br />.... _................ ...._............_ _ .. ... _......._._..._._...____.______........_______..._.._...._.._.e________.......,
<br />AUTOMOBILE LIABILITY
<br />...._ ..
<br />COMBINED SINGLE LIMIT S
<br />(Ea accident)._. .__.
<br />_....
<br />_.... ....... 1,000,000
<br />G X ANY AUTO ACP3016645740 06124/2015 06/24/2016
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident) S
<br />AUTOS AUTOS
<br />X
<br />(P
<br />HIRED AUTOS AUTOSWNED
<br />ra ciident�AMAOE
<br />S
<br />UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE $
<br />2„000,000
<br />C X EXCESS LIAR CLAIMS -MADE NHA238192 06124/2015 06124/2016
<br />AGGREGATE $
<br />DEO X RETENTION$ ... 0:'.
<br />......... ........ .__. $..__..
<br />2,000,000
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />STATUTE FIR
<br />AND EMPLOYERS` LIABILITY N
<br />....1,,000,000
<br />D ANY PROPRIETORIPARTNERIEXECUTIVE 911051314 09/0112014 09/01/2015
<br />N NIA
<br />ELL EACH ACCIDENT 5
<br />OFFICER/MEMBER EXCLUDED?
<br />....
<br />...
<br />(Mandatory In NH) ._....._
<br />E.L. DISEASE - EA EMPLOYEE 5
<br />1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />,.
<br />EJ_ DISEASE - POLICY LIMIT 5
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks. Schedule,: may he attached if more space is required)
<br />Job: Operations pertaining to named insured for certholder. Certholder is add'I insd as respects gen'I liab per end't attached.
<br />I
<br />Ls(. ".p..
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Attn: Water Resources AP
<br />220 S Daisy Ave
<br />Santa Ana, CA 92703
<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 />AUTHORIZED REPRESENTATIVE
<br />@ 1988-201'4 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />V
<br />V
<br />
|