|
CWFINCA -01 NCADWALLADER
<br />A o' CERTIFICATE OF LIABILITY INSURANCE DATE NMW
<br />015YY)
<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 BYTHEPOLICIES
<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(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 CONTACT
<br />NAME:
<br />Bolton & Company PHONE FAX
<br />3475 E. Foothill Blvd, Suite 100 LI1NO E :h (626) 799 -7000 AIC No): (626 ) 441 -3233
<br />Pasadena, CA 91107 EMAIL _ --
<br />ADDRESS:
<br />INSURERIS) AFFORDING COVERAGE NAIC p
<br />INSURER-A: Samsung Fire & Marine Insurance Co. .38300
<br />INSURED INSURER e: Travelers Prop Cas Co of Amer 25674
<br />CWF, Inc. DBA Al Party Rentals INSURER C:
<br />251 E. Front Street INSURER D
<br />Covina, CA 91723 _ INSURER E:
<br />INSURER F :
<br />r..nVERAQEB nFRTIEI(`.ATE MIIMRPR- REVISION NIIMRFR-
<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
<br />ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED
<br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
<br />ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR �SUBR.- -
<br />LTR TYPE OFINSURANCE p p POLICY NUMBER
<br />POLICYEFF POLICY E %P`
<br />MMIDDIVYYY MMIDC6EXP LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />--
<br />CLAIMS -MADE X OCCUR X :CPR 006511200
<br />DAWGET6RENTED
<br />.02/0112015 02/01/2016 PREMISES (Ea occurrence) '$
<br />500,000
<br />MED EXP (Any one person) '',
<br />$ 10,000
<br />PERSONAL$ ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLI ES PER
<br />_GENERAL AGGREGATE
<br />$ 2,000,000
<br />_G_ENL
<br />POLICY X jECOT X : LOD
<br />PRODUCTS- COMPIOPAGG
<br />$ 2,000,000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident
<br />$ 1,000,000
<br />A X ANY AUTO CPP 0065112 00
<br />0210112015 02/0112016 BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />$
<br />_ -., AUTOS _ AUTOS
<br />X X NON -OWNED
<br />: PROPERTY DAMAGE
<br />$
<br />HIRED AUTOS AUTOS
<br />Per arecent)
<br />X UMBRELLA LAG X OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A —, EXCESS LIAB : CLAIMS -MADE UMB000269100
<br />02/01/2015 02/01/2016 AGGREGATE
<br />$
<br />DED X RETENTION$ 0
<br />Aggregate .$
<br />5,000,000
<br />WORKERS COMPENSATION
<br />X PER HI
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />13 ANY PROPRIETORIPARTNERIEXECUTIVE XJUB3804TB5614
<br />11101/2014 11/01/2015 EL EACHACCIDENT
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED? IT
<br />-- -
<br />-�
<br />1,000,000
<br />'(Mandatory in NH)
<br />EL DISEASE -EA EMPLOYER$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: Operations of the Named Insured, The City of Santa Ana, it's officers, employees, agents, and representative are named as additional
<br />insured per the
<br />SS02010111 attached. Cancellation Clause applies per the IL00171198 attached.
<br />Reviewed by.
<br />US'
<br />)j(1
<br />/X ITI.R'
<br />Silvia Cuevas
<br />114
<br />City of Santa Ana
<br />Finance & Management Services Agency
<br />20 Civic Center Plaza
<br />PO Box 1988 M -16
<br />Santa Ana, CA 92702
<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 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|