|
271069
<br />DATE (MMID01'YYYYI
<br />�,....-- CERTIFICATE OF LIABILITY INSURANCE 12/22/201:5
<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(les) must be endorsed. If SUBROGATION IS WAIVED„ subject to
<br />the terms and conditions of the policy„ certain policies may regluire 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 Catherine Cory.
<br />Commercial Linos - (818) 464-0300 PRONE FAX
<br />Inlc, Nom, Ext):
<br />818-464-9458 (AIC, No); B66-968-5687
<br />Walls Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 E-MAIL
<br />ADDRESS: cory@welisfargo.com
<br />co ,rWellsfar o,Cam
<br />.-- �
<br />�
<br />15303 Ventura Boulevard, 7th Floor IN�...SURER(S) AFFORDING COVERAGE ....... IJAIC #
<br />Sherman Oaks, CA 91403-3197 INSURER A: Philadelphia Indemnity Insurance Company 18058
<br />INSURED
<br />INSURER e: Employers Compensation Ins Co 11512
<br />Discovery Science Center of Orange County. ....
<br />INSURER D
<br />2500 North Main Street
<br />INSURER D, I
<br />Santa Ana, CA 92705 -
<br />COVF'RAnF:S CFRTIFICATF NIIMRFR• 9919 1 RF\neZInIU NIItMRFR• .COIL pla,.o
<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 />,,.�.��. ,
<br />INBR IADDL
<br />LTR TYPE OF INSURANCE
<br />SUBR _ POLICY EFF,
<br />INSD WVD POLICY NUMBER MMIDWYYYYMMIDDPYYYY
<br />POLICY EX.P
<br />--._. _..
<br />F _ UMrTS
<br />X COMMERCIAL GENERAL LIABILITY
<br />A .
<br />�1 �
<br />X PHPK1432448 1211512015 12115120161
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTE6
<br />� 5 1,000.000
<br />CLAIMS -MADE X OCCUiRhA1SE5,(Es_,
<br />raccvr�ncel
<br />5 1,000.000
<br />"...-
<br />1
<br />MEDEXP (Any one person)
<br />PERSONAL. & ADV INJURY
<br />GENEHAL AGGREGATE
<br />5 20,000
<br />51,000,006
<br />�S 2.600,000..
<br />GEIN'L AGGREGATE LIMIT APPLIES PER ....._.
<br />X POLICY PRO` j L00
<br />--.� .VECT 1
<br />1
<br />P.R00LIL.1"S - COMIPIOP AGG
<br />5 2,000,000
<br />IaTHER..
<br />Sexual Abuse/Molestation
<br />r
<br />S Included
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK1432448 12!1512015 1211b12016
<br />WM81NED SI'..NGLE. LIMIT
<br />_LEa.:rdopll
<br />1,004,040
<br />X]AUTOS
<br />ANY AUTO
<br />1
<br />00DIV-Y INJURY (Per person p
<br />S
<br />ALL OWNED ........ SCHEDULED
<br />AUTOS
<br />� I
<br />-
<br />BODILY INJURY (Per accident)
<br />i 5
<br />X
<br />X NON -OWNED
<br />R PERTY DAMAGE
<br />G),accoden..
<br />" --
<br />S
<br />HIRED AUTOS AUTOS
<br />Per
<br />5
<br />UMBRELLA LIAR [Xi OCCUR
<br />PHUB524655 12115/2015 1211512016
<br />EACH OCCURRENCE
<br />............ 10,D00.DJD
<br />---- EXCESS LIAR CLAIMS MADE
<br />AGGREGATE
<br />5
<br />DFD RETENTIONS
<br />S
<br />B
<br />WORKERS COMPENSATIONPER
<br />FIG145381 3-03 04101115 041D1/16
<br />1,1TR-
<br />X I_. STATUTE.ER
<br />i
<br />AND EMPLOYERS' LIABILITY 1" 7 N
<br />_
<br />------ _ _.
<br />ANY PROPRIETORIPARTNERrEXECuUTOVE
<br />IACCIDENT
<br />1.000,004
<br />OFFICERMEMaER EXOLUFN
<br />NIA
<br />-
<br />.. --.... -
<br />r ........
<br />(Mandatory in NH)
<br />E . DISEASE: - EA EMPLOYEE
<br />5 },,000.044
<br />4es
<br />describe under
<br />SCRIPTDN OF OPERATIONS below
<br />____-
<br />—,
<br />E.L. DISEASE -POLICY LIMIT
<br />r... ....... _.__........ . _.
<br />5 1,000 000
<br />I
<br />I
<br />I
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (ACORD 101., Additional Remarks Schedule, may he attached it more space is required)
<br />The City of Santa Ana, 20 Civic Canter Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as
<br />Additional Insureds for General Liability and defense of suits arising from the operations and uses performed by or on behalf of the Named Insured per the
<br />attached. Cancellation Notice to Scheduled Additlonal Insured also attached, The coverage is primary and non-contributory with other insurance held by
<br />the City. Separation of insureds applicable per the policy form.
<br />DIF-1It,VNIP,111IC19(u't°Cb.
<br />r'"1=RTIFI(`ATF HI nFR r"AR rrl I ATl('1AI'
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Attn: Risk Management
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE, WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />The ACORD name and logo are registered marks of ACORD @ 19'85'-2014 ACORD CORPORATION.. All rights reserved.
<br />ACORD 25 (2014/01)
<br />
|