|
ACC?Ra
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />�TEDDYYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />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 CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERi 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 .
<br />CONTACT Halidee Calle'jas
<br />10C Insurance Services
<br />PHONE(415 357-0600 � FAX), A!C. No( Ext! ....__. ............. ........ _�AIC,..N.al: (415Y 957-0577
<br />E-MAIL -
<br />License No. 0589950 .,of
<br />hcalle'as@mocins.com
<br />_ ADDRESS; hcallejas@mocins.com
<br />44 Montgomery St., 17th Fl.
<br />�NAIC#
<br />San Francisco CA 94104
<br />INSURERA Citizens Insurance Co of America 31534
<br />INSURED
<br />INSURER 6 Allmerica..,,.Financial Benefit Co. 4..1840
<br />Keyser Marston Associates, Inc.
<br />INSURERC:Republic Indemnity 22173
<br />INSURER D;Evanston Insurance C.o. 35378
<br />I
<br />160 Pacific Avenue, Suite 204
<br />INSURER E;
<br />San Francisco CA 94111 (A---
<br />-
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER:2015-20117 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUHR..
<br />WVD
<br />._._.._..,,, .
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDYYYYY)
<br />POLICY EXP
<br />(MMIDDNYYYI
<br />....-....... ._ ..
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />CLAIMS -MADE � OCCUR
<br />PREMGESIEa RENTED
<br />PREMISES Ea occuLrzrece)
<br />$ 500,000
<br />MED EXP (Anyone person)
<br />$ 10,000
<br />X
<br />ZDFA49104901
<br />12/1./2015
<br />12/1/21115
<br />No Deductible Applies
<br />PERSONAL €. ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />H,
<br />POLICY X PRO- LOC
<br />PRODUCTS - COMPYOP AGO
<br />$ Included
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />_,(Ea accidenll..
<br />$ 1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Peraccdent)
<br />$
<br />..,
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />AwFA49004901
<br />12/1/2015
<br />12/1/2016
<br />X
<br />X NON -OWNED
<br />F ROPER7Y DAMAGE
<br />_
<br />$
<br />HIRED AUTOS AUTOS
<br />Per accident) .....,....._
<br />....,..
<br />X
<br />Comp $500 X Coil $500
<br />Uninsured Motorist combined
<br />$ 1,000,000
<br />Xd
<br />UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />A
<br />EXCESS LIAR CLAIMS -MADE,
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X I RETENTION$ N/A
<br />$
<br />X
<br />UHFA49117101
<br />12/1/2015
<br />12/1/2016
<br />WORKERS COMPENSATION
<br />X I
<br />AND EMPLOYERS' LIABILITY Y / N
<br />'STATUTEa'
<br />_.__ .,...._
<br />E L EACf-I.... ACCIDENT
<br />ANY PROPRIETORIPARTNERIEXECUTIVE "......._.
<br />OFFICERIMEMBER EXCLUDED? �. 1
<br />N d A.
<br />-.
<br />C
<br />_
<br />(Mandatary in i_
<br />03559621
<br />12/1/2015
<br />12/1/2015
<br />E L DISEASE.LA EMPLOYE
<br />$ $ 1,000 0,00
<br />If yes, describe under
<br />'.,,.
<br />,
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />Professional Liability
<br />EOB61972
<br />12/'1/2015
<br />12/1/2016
<br />Each Wrongful Act $1,000,000
<br />D
<br />Retention $25,000
<br />RL-tro Date: .11/11/1976
<br />AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required],
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premium.
<br />City of Santa Ana
<br />Executive Director of CDA
<br />20 Civic Center Plaza M-25
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014101)
<br />INS025 (201401)
<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 />&➢a, 1l.l.,dee CaTlejas/FICA
<br />zin A -.ter,
<br />1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|