COAST LIVE OAK SCHOOL (2) - 2014

Home Browse Search

ACIII CERTIFICATE OF LIABILITY INSURANCE AT 922014D/YYYY) 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. APORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 PRODUCER LUNIAbr - Vy Selller-Flynn Wood Gutmann & Bogart License#0679263 - FAX PHONE (AIC,NoEXt1714-505-7000_ _�(Pic,Noll 714-573-1770 15901 Red Hill Ave., Suite 100 E-MAIL ,vy@wgbib.com - APORESS Tustin CA 92780 INSURER(S) AFFORDING COVERAGE NAIC# _- _COAST06 -. __.. INSURER Indemnity Ins CO. INSURED I INSURER B: Coast Live Oak School _ INSURER C: Mark Hay -- - 316 Edgewood Road INSURER D Santa Ana CA 92706 9C)4y---0c) INSURER E INSURER F UUVERAGES CERTIFICATE NUMBER: '192200dti/1 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 CONTRACT OR 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. DD SUBR� INSRi ANSD WVD POLICY NUMBER LTR' TYPE OF INSURANCE POLICY EFF POLICY EXP MWDDIYYYYI ffAM/DD1YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK1220574 9/22/2014 9/22/2015 EACH OCCURRENCE $1000000 CLAIMS -MADE OCCUR DAMAGE TO RENTEDPREMISES.(Eaaoccurrence) - - - _ -XI $ID0000 - _ MED EXP (Any one person) $5,000 PERSONAL A ADV INJURY $1000000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2000000 PRO 1'. POLICY l LOC •, JECT PRODUCTS COMPIOP AGG $2000000 OTHER _. $ AUT AUTOMOBILE - _ LIABILITY 1� MBINED SI G LIMIT ANY AUTO C.L, - S G DI INJURY( Perperoan) $ _ ALTOS SCHEDULED AUTOS AUTOS �t1,..�a WT $ BODILY INJURY Peraccment ( ) _ NON OWNED HIRED AUTOS AUTOS � PROPERTY DAMAGE -.. I4 $ _-i _ _ �h (Per accitlenl) UMBRELLA LIAR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE!�$_ _ AGGREGATE DED RETENTI� $OCCUR S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/Ni PER OTH _ STATUTE _� ER I ANY PROPRIETORIPARTNEWEXECUTVE NIA EL EACH ACCIDENT OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E L DISEASE - EA EMPLOYEE 5 If yes tlescrlbe under - -- - DESCRIPTION OF OPERATIONS below l E.L. DISEASE - POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Atltllllonal Remarks Schedule, may he attaches If more space is required) City of Santa Ana, its officers, agents and employees are named as additional insured on the General Liability per attached PI GILD VS 01 08. Cancellation verbiage as per IL0017 11 98 attached. Primary and Non -Contributory applies on the General Liability per attached PI GILD VS 01 08. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED, City of Santa Ana; Parks, Recreation and Community Services Agency Attn: Carmen Acosta 1825 W, Civic Center Drive 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 r24' xn�0`7 @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD