|
z '° RTIFI L`T OF LIABILITY INSUR I aarE 17/2 "'7(2nnYrY,'
<br />3/015
<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 CERTIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT DEPRESS[ THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy)los) most be endorsed, if SUBROGATION IS WAIVED, subject to
<br />the forms and conditions of the policy, certain policies may requite, On andorseme'nt. A statement on this certificate dons not confer d9lits to the
<br />certificate holder in Sloo of such sndorsemonk(s). _
<br />PRODUOPR CONTACTNAME je Lry Noyola �^�
<br />Gxsyliny Insurance Brokerage PHON=. (779)552-4225 F.Ax taasl sso-aunz
<br />ur. No
<br />3?89 Mansell Teead.'f'��'�,_jy.noyaJ.�z@greylincJ. com
<br />Suite 370 MSWRERr9r AFPOHt Nm _C2SERAGE NAICk
<br />Alpharetta GA 30022 _ INSURESA;Niaticinal. Union Fire Iris Co 19445
<br />1r:suRE➢ w NsURECN iTravelers Pro ert Casualty 5674
<br />Psomas INSURER C ,
<br />555 S. ''lawar Street INSURER o: .__._..__._.._
<br />Suite 4300 INSURED E:--'---- --- _
<br />Los Angeles CA 90071 _ INSURER F�
<br />COVERAGES CERTIFICATE NUMBER:15-16 REVISION NUMBER:
<br />THIS i4 TO CERTIFY [I Al THE POI ICIES OF INSURANCE, LISTED BELOW FIAVF BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICIA'I'ED. NOTAG 11 S IANDINt3 ANY REQUIREMENT. TERM OR C7NDI'TION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY 3E ISSUED OR MAY PERTAIN THE INSURANCE AFF(ARDED BY THE POLICIES DESCRIBED HEREIN IS BUBJEC' TO ALL THE TERMS,
<br />EXCLUSIONS AN:;) CONgtlll ,NS OF SUCFI POLICIES. LIMITS SHOWN MAY HAVE BEEP! REDUCED Bi PAID CLAIMS.
<br />INSR A LSl SH —� POLICY EFF POLICY EXP—
<br />LTR T'IVE OF INSURANCE _ PgLICY NUhtEER IY b1M!➢ fYYY _—_-- LIMITS
<br />GENERAL LABILITY EA(:H JCCURRENCE g ]., 000,000
<br />X COMME�DANIA ETO ON Nu,
<br />fEC i N Rf+1 CPn'4.I?v R _b IS S f N f500, 000
<br />$ CLl IM19 F9 OI `� ) CJ. �2097 G38 4/E/701.14 4J1/2016 bIPp FX A,s rsoil 5 25,000
<br />X Contxaccuai ti.isla.11it _ PERSONA, a Air, INJUPI s 1,000,000
<br />a9rwRaL n¢GRe'GmTE a P,000, 000
<br />6MI At ,3REtA a-. APil fo3 ocrA' PRODUCTS C]l0!'AcG$ 2,000,000
<br />UL'ar R �,L,Fy- X
<br />AUTOMOSILE UASILITY C Rrt9INE'J b ml r Llm l`
<br />e„ madNm. _ 1 000.006_
<br />A x +NY AI fID EgDIIYI U1YtPo
<br />ALL 00 ' AtiIrIL� i.ASC: 'tB 1dF153 alli2)Av 4t11 e➢1S
<br />110DEYI! JnY Pv �_:'
<br />,I,SKI ,1NCD PROPrT YTAD,IASE
<br />' HIRED /,I , Ail'I I IPa' a
<br />Ob1HiYE:,LA lIA3 ,)1s;11i'L s LAObRiIX;UiiitP: NCE:
<br />EXCESS LIAR CLIInIrrMAC1E AGGREGATE
<br />A. 4vORKEAS COMPENSATION jSgpjd pp (Gaol 4f11sN1u 2)1(AG..6 4 S J T TII
<br />AND EMPLJYE S UADLLTY YIN -. )b _ _ LPiI
<br />tr , riryil {I °'rNi ® NfA EL E1 1 )E I. _ a., D00 000
<br />(MA dHxvyinhk 345C119E tCd) a('I'2015 A;l 2.iG K 1 F t P d -
<br />1, 0001000
<br />,. 0-1I ,I aL�_ n 1, 006 coo
<br />I
<br />DESCRIPTION OF OP SAVONS ) LOC YMONSI VEHICLES (Aft'Pi ACORD 10t, Addliim=ai RAPa%, SCL W via. it oiOPi epaaa 1s; Aiwn l)
<br />4dEN0201.20. The City of Santa ADD, lt5 Of'i"Y:;O.t'9, f9tinV lo,Taos, agent,3, NGaDRtIoal^s & rPl,'e,"). '.o, e3 3SLR
<br />nmc,od e.a Additional Xizsuccdo wits. r4's+spectr to Craver A;. & Automobile Ifo,obi:i,ity where requirad by wxiti.Gra
<br />contczo.,M. Pha above refexenced 1iabxi.Lty po].,o,%ea ace primary 6 ngti-Pon@.ributa.ry whaze regOirsd by
<br />written coot:raact- Waivor of Suicrogat-on ppLI,)s to G_n4ra] Liability & Aorkresrs COuip „nsttion where
<br />ragtx acrt by wr r 'tan < ov rrau't. f� /jJ'
<br />FISORAS AGRFEMEN- A 2UOS-21b RE VIBAIIH7 BY 1 Ny EUNICE HE( EDIA ir'(a 1 OF 7)
<br />SHO'M.D A.NY OF THE ABOVE DESiiRCTOO) POLICIES BE CANCELL ED 113EFORE
<br />THE EXPRATIGN DATE THEREOF, NOTICE WILL BE D"e LIYEREC IN
<br />City Gi Santa Ana,
<br />m,`CORDANCE rP71T}{ fltiE POI,7CY NR0V10141N5.
<br />A3lertc Of. iI City aou.eleil Aun-Inrlr ➢I<c a=;elarnrlva .�....__..__.�._.
<br />2G Civic _costar Fraaa
<br />Sw; tr .Arta, I -A 92 702
<br />.em'.yp.uP
<br />RACORO 2fi {2RVtFQ51 � .—��� �. �0 7S6ss-20"0 AvORC= Ci?RPOR9.T3C7N. Adt riCghYr, ras trued.
<br />)di507R r
<br />
|