|
�'..1141 GOVESTA-02 PPISANO
<br /> ACC)RO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br /> �� 6/2/2015
<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 CONSTITU7 A cO R T BETWEEN THE ISSUING INSURER(S),AUTHORIZED
<br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE�FICrl,LDtR —) Ail 1J.
<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 ma Jre r4 endorspment.-A statement on this certificate does not confer rights to the
<br /> certificate holder in lieu of such endorsement(s). (x f) ] Ui' J 1;(s f
<br /> PRODUCER CLERK (INAOMTACT
<br /> CTK North American Insurance Services,LLC PHONE FAX
<br /> 1240 North Lakeview Avenue,#240 _mac,No,Ext):(714)779-2000 (Afo,No):(714)779-4129
<br /> Anaheim,CA 92807 E-MAILD
<br /> ADDDRESS:
<br /> ��/
<br /> �f — 0€0 /r N--V 0> c,0 INSURER(S)AFFORDINGCOVERAGE NAILS
<br /> /1� INSURERA:Zurich American Insurance Co.of IL 27855
<br /> INSURED INSURER B:American Guarantee and Liability Ins.Co. 26247
<br /> Government Staffing Service dba:Munitemps INSURER C:
<br /> P.O.Box 718 INSURER D:
<br /> Imperial Beach,CA 91933 INSURERS: _
<br /> INSURER F:
<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 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 ADDL SUER - - - -i POLICY EFF POLICY EXP -LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER !(MM/DDIYYYY) (MMIDD/YYYY) LIMITS
<br /> A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> ___I CLAIMS-MADE LX�OCCUR X PRA969906303 . 05/10/2015 05/10/2016 DAMAI.E TO1 CNTI_o
<br /> PREMISES(Ea occurrence) $ 100,000
<br /> MED EXP(Any one person) $ 10,000
<br /> PERSONAL&ADV INJURY $ 1,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
<br /> X ;POLICY; JECT1 PRO- �—; LOC I i PRODUCTS-COMP/OPAGG $ 2,000,000
<br /> OTHER: I I $
<br /> I AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ 1,000,000
<br /> A _ _�Ea accident)
<br /> A 1
<br /> ANY AUTO PRA969906303 05/10/2015 05/10/2016 BODILY INJURY(Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
<br /> AUTOS AUTOS
<br /> X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE
<br /> _Per accident) $
<br /> I $
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
<br /> B EXCESS LIAB CLAIMS-MADE LIMB946734703 05/10/2015 05/10/2016 AGGREGATE _ $ 1,000,000
<br /> DED X RETENTION$ 0 $
<br /> WORKERS COMPENSATION I I PER 1OTH-
<br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
<br /> OFFICER/MEMBER EXCLUDED? LiN/A ----
<br /> (Mandatory In NH) - . E.L.DISEASE-EA EMPLOYEE $
<br /> If yes,describe under - - - --
<br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
<br /> A Crime i 'PRA969906303 05/10/2015 05/10/2016 2,500 Deductible 100,000
<br /> A Professional Liab IPRA969906303 05/10/2015 05/10/2016 $1m/$2m
<br /> DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
<br /> Schedule of Named Insured(s)
<br /> Ce CZ . i .,...._' —%--._
<br /> Government Staffing Service dba:Herrera&Associates Staffing Services / C/`t
<br /> Government Staffing Service dba:Munigroup �'Lf`
<br /> Government Staffing Service dba:Munitemps
<br /> Government Staffing Service dba:Munistaff c
<br /> SEE ATTACHED ACORD 101 3
<br /> CERTIFICATE HOLDER CANCELLATION {/�fN
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> Ct : Ellen Smiley ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> 20 Civic Center Plaza
<br /> Santa Ana,CA 92701 AUTHORIZED REPRESENTATIVE
<br /> 4,,,,,a/,...4.,
<br /> ©1988-2014 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|