|
___`,, TANKO LIGHTING AGR# TBD
<br />i
<br />REVIEWED BY: " v
<br />i'll"t - EUNICE HEREDIA (PG 1 OF 17)
<br />Ac."my CERTIFICATE OF LIABILITY INSURANCE
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />`�
<br />08/07/201YYY)
<br />08/07/2015
<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 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 LIC #0056172 1-888-845-2248
<br />CONTACT
<br />NCSherry & Hudson
<br />NAME
<br />PHONE FAX
<br />AC No Ent: 408-550-2130 AIC No: 408-550-2119
<br />EMAIL
<br />ADDRESS:
<br />160 West Santa Clara Street
<br />Suite 715
<br />EACH OCCURRENCE $2,000,000
<br />San Jose, CA 95113
<br />INSURERS AFFORDING COVERAGE NAIC it
<br />INSURERA: TRAVELERS PROP CAS CO OF AMER 25674
<br />INSURED
<br />INSURERS: CAPITOL SPECIALTY INS CORP 10328
<br />Tanks Street Lighting, Inc.
<br />DA AGET RENTED 100,000
<br />PREMISES Ea occurrence $
<br />DBA: Tanko Lighting
<br />INSURERC:
<br />INSURER D:
<br />1000 Quesada Avenue
<br />INSURERE:
<br />San Francisco, CA 94124
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 44756230 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 />R
<br />OF INSURANCE
<br />ADDTYPE
<br />INSR
<br />MIDSIUBR
<br />POLICY NUMBER
<br />MMIODNYYYY
<br />MMIDDIIYYVY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />630 -4E925604 -TIL -15
<br />04/17/1
<br />04/17/16
<br />EACH OCCURRENCE $2,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I JOCCUR
<br />DA AGET RENTED 100,000
<br />PREMISES Ea occurrence $
<br />MED ENE (Any one person) $5,000
<br />PERSONAL B ADV INJURY $2,000,000
<br />GENERAL AGGREGATE $4,000,000
<br />GEN'LAGGREGATE
<br />LIMITAPPLIES PER:
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />X POLICY
<br />PRO- LOC
<br />JECT
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />BA -4E937756 -15 -CAG
<br />04/17/1
<br />04/17/16
<br />COMBINED SINGLE LIMIT
<br />Ea acodent 1,000,000
<br />BODILY INJURY (Per person) $
<br />X
<br />ANY AUTO
<br />ALL OWNED F SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />tier sccldent
<br />A
<br />X
<br />UMBRELLA LIABX
<br />OCCUR
<br />CUP -48925604 -TIL -15
<br />04/17/1
<br />04/17/16
<br />EACH OCCURRENCE $ 3,000,000
<br />AGGREGATE $ 3,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />X
<br />UE -4E963854-1505/19/1
<br />05/19/16
<br />% WC STATU OTH-
<br />I
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? Y
<br />NIA
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mantlatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1, 00 0, 000
<br />H
<br />Professional E&O
<br />SGC03229-04
<br />--o-47-3.77—m-
<br />04/17/16
<br />Each Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is requ imd)
<br />RE: Analyses.
<br />Additional Insureds: City of Santa Ana, its City Council, boards, commissions, their officers, employees and agents.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010/05)
<br />orilsonkl9
<br />44756230
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn:
<br />Ross Annex
<br />Civic
<br />Santa
<br />Center Plaza, 3rd Floor Reception
<br />Ana, CA 94087
<br />AUTHORIZED REPRESENTATIVE //,'%�/�. �,/�
<br />r �A'
<br />USA
<br />�' `^ '
<br />ACORD 25 (2010/05)
<br />orilsonkl9
<br />44756230
<br />© 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|