Laserfiche WebLink
ACORO <br />® CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIDD YYY) <br />DanarzOis <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF I MY(f)QN•iONLYrAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOA7 VELY AMEND,.ElCTID lO& 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 CE E 911-y'5. <br />IMPORTANT: If the certificate holder is an ADDITI L4[iV R Vital CY(les must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain poli Has y mcliJim an Endorsement: A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endomement(s). <br />PRODUCER <br />Ann Risk Services Northeast, Inc. <br />New York NY office <br />CONTACT <br />NAME: <br />N (066) 193-7122 FAX (800) 363-0105 <br />INC. No.Eaq: AIC. NP.: <br />E-MAIL <br />ADDRESS: <br />199 water Street <br />New York NY 10038-3551 USA <br />INSURER(S) AFFORDING COVERAGE NAG# <br />INSURED <br />ICF Jones & Stokes. Inc. <br />INSURERA: Great Northern insurance Co. 20303 <br />INSURER 8: Pacific Indemnity CO 20346 <br />9300 Lee Highway <br />Fairfax VA 22031-1207 USA <br />C: AXIS Surplus Insurance Company 26620 <br />URER D: <br />X pano-aclual Liability <br />rINSURER <br />URERSURER <br />N-ams- i5q <br />F: <br />COVERAGES CFRTTFICATP NtIMRFR- 570058998501 <br />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. Limits shown are as requested <br />INIM <br />TYPE OFINSURANCE <br />Irygp <br />OYVD <br />POUCYNIJ <br />POLIGYEFFLTR <br />MMID <br />F moA'YYY <br />11MRs <br />A <br />X COMMERCUILGENERALUU311JTY <br />CLAIMS -MADE X❑ OCCUR <br />3531-Z4-U <br />Package - Domestic <br />EACHOCCURRENCE $1,000,000 <br />$1,000,000 <br />PREMISES Ee occwrence <br />MED EXP (My one pereonl $10,000 <br />X pano-aclual Liability <br />PERSONAL a ADV INJURY $1,000,000 <br />GEN'L AGGREGATE LIMITAPPLIES PER. <br />GENERALAGGREGATE $2,000,000 <br />- COMPIOPAGG 52,000,000 <br />X POLICY ❑ PROT F—]LOCPRODUCTS <br />JEC <br />OTHER. <br />A <br />AUTOMOBILE LIABILITY <br />7352-29-55 <br />Automobile - All States <br />06/2 5/2015 <br />07/01/2016 <br />COMBINED SINGLE LIMIT $1,000,000 <br />Ea accident) <br />BODILY INJURY I Per Remain <br />% ANY AUTO <br />BODILY INJURY (Pareaident) <br />ALL OWNEDSCHEDULED <br />AUTOS AUTOS <br />X HIREDAUTOS X N.NLOWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />UMBRELLA LMB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESS UAB <br />CLAIMS -MADE <br />DED <br />RETENTION <br />B <br />WORKERS COMPENSATIONAND <br />175-43-37 <br />6 <br />X I PER STATUTE OTN- <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORI PARTNERI EXECUTIVE <br />OFFCERIMEMBER EXCLUDED? MNNIA <br />(Mandl in" <br />workers Comp <br />E.L. EACHADCIDENT $1,000,000 <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />IIy describe under SCRIPTION OF OPERATIONS below <br />DE <br />E.L. DISEASE -POLICY LIMIT $1,000,000 <br />c <br />E&O-MPL-Primary <br />E62768043/01/2015 <br />Errors &omissions <br />06/2 5/2 015 <br />07/01/2016 <br />Prof Liab Agg - All $1,000,000 <br />Overall policy aggri 81,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD i01, Mandrel Remarks Bobedule, may be attached IT mora space Ie rectored) <br />1 - Professional Liability is a Claims Made policy. There is no Additional Insured status on the Professional Liability <br />coverage. <br />2 - The city of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds <br />as respect General Liability. //'/jylay-'/� <br />' 'I 4 <br />d <br />CERTIFICATE HOLDER CANCELLATION - rj La <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEpP BEFOREDTHE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />City of Santa Ana AUTHORQED REPRESENTATIVE -- <br />c/o Clerk of the Council <br />20 Civic Center Plaza tJ�n �r _�,? , ^ r_ <br />P.O. aux c1988 <br />ent (✓/YJl cL/-Y �/ <br />Santa Ana, CA 92702-1988 USA iLesaaOU _ _ . _L <br />01988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />