Laserfiche WebLink
As.... "R" DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE DATE <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(ies) 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 CONTACT <br />NAME: Delgado <br />Pearas & Associates Insurance Brokers PHONE Ext; (8_00) 578 8802 (AMINO,4818)4419-9321 <br />CA License #0814733 EMAIL wdelgadopomsassoe.com <br />ADDRESS: <br />5700 Canoga Ave. #400 �_____.___....._._.INSURER;s)AFPbRDINGCGVERA.GE..._ NAICid _. <br />_......._ _ _ _... _ _..... <br />Woodland Hills CA 911367 INSURERa The American Insurance Company 21857 <br />INSURED INSURERB;Technolocry Insurance Co. Inc <br />MCCUNE & HARBER, LLP. INSURERC;Allied world Assurance <br />515 S Figueroa St, Ste 11,00 INSURERI <br />Lias Angeles CA 90071 1 INSURER F: <br />COVERAGES CERTIFICATE NUMFIFR-CL166341664 RFVI.glnN NI IIIJI <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 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 />LTR <br />TYPE OF INSURANCE <br />:ADDLSUBR......_... <br />.-_-,.._, <br />POLICY NUMBER. <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMfDDIYY <br />— _........ ......_...._...._ <br />LIMITS <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$, 2,000, 000 <br />A <br />CLAIMS -MADE........ OCCUR <br />DAMAGETORENTED __. <br />PREMISES Eaaaavrrehce-.._...$ <br />_........... 1.00,000 <br />MED EXP (Any one person) <br />$. 10,000 <br />. _ <br />AZC80884450 <br />4/1B/2016 <br />4/18/2017 <br />PERSONAL, & ADV INJURY <br />$.. 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER.; <br />GENERAL AGGREGATE. <br />$ 4,000,000 <br />X P'OUCY EI JECT (� LOC <br />PRODUCTS.. COMP/OP AGG <br />$ 4,000,000 <br />_..... <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY <br />COMBEED SINGLE LIMIT <br />ga accidenO <br />$... 2,000,000 <br />A <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY <br />$ <br />ALL OWNED SCHEDULED <br />_..__ AUTOS _ AUTOS <br />AZC80884450 <br />4/1.8/2016 <br />4/18/2017 <br />ICON -OWNED <br />X <br />PROPERTY DAM,4GE <br />$ <br />FIR ED AUTOSAUTOS.. <br />Per ar..idenkj _._._ <br />$ <br />UMBRELLA LIAB <br />HOCCUR <br />EACH OCCURRENCE <br />'.., $ <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />'X '... STATUTE '..... °R" <br />AND EMPLOYERS' LIABILITY Y I N <br />�' <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />ANY PROPRIETORFPARTNERIEXECUTIVE '° <br />B <br />OFFICERJMEMBER EXCLUDED? <br />(Mandatary in NH) <br />N 1 A <br />IITWC354,8429 <br />5/15/2016 <br />5/15/2417 <br />_ <br />E.LDISEASE- EAEMPLOYE <br />$ 1 00p pop <br />if yes, describe under <br />__......_.,....... <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT I <br />$ 1,000,000 <br />C <br />Professional Liabililty <br />0309-6325 <br />6/4/2016 <br />6/4/2017 <br />Fach Claim $1,000,000 <br />Ag re to $1,Opp,Opp <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 109, Additional Remarks Schedule, may be attached if more space is re mf�e ) . , '0 <br />Evidence of Insurance Only, 1 i�� <br />(, <br />Sandra M. S INva"Ma"n <br />senior Assistant City Attorney <br />I4 -1I 111Wi1ILei a <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City Attorney's Office ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Mail Strap -29 AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701r"{ <br />Wendy Delgada/WDELGA, <br />®1988-201 9 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />INS025 or inot) <br />