|
A� V CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM /DD/YYYY)
<br />04/15/2016
<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(ies) 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 />Pro -Form Sinclair Professional
<br />675 Cochrane Drive
<br />CONTACT Susan McInnes
<br />NAME:
<br />PHONE
<br />/CC, No, Ext ; 905- 305 -1054 FAX No : 9O5- 305 -1093
<br />Suite 200, East Tower
<br />Markham, ON L3R 0138
<br />E-MAIL
<br />ADDRESS: susan.mcinnes@hubinternational.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A :XL Specialty Insurance Company
<br />37885
<br />04/30/2017
<br />INSURED
<br />IBI Group
<br />INSURER B :XL Specialty Insurance Company
<br />37885
<br />INSURER C
<br />18401 Von Karman Avenue, Suite 110
<br />Irvine, CA 92612
<br />INSURER D
<br />$ 300,000
<br />INSURER E,
<br />MED EXP (Any one person)
<br />$ 5,000
<br />INSURER F
<br />Contractual Liability
<br />COVERAGES CERTIFICATE NUMBER:EEQU5CQJ 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 />ILTR
<br />TYPE OF INSURANCE
<br />AINSD
<br />SWVD
<br />POLICY NUMBER
<br />MM /DD�YY
<br />MM DDfYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />US00008537LI16A
<br />04/30/2016
<br />04/30/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />CLAIMS -MADE 7 OCCUR
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />Contractual Liability
<br />PERSONAL & ADV INJURY_
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />X POLICY ❑ PRO-
<br />JECT ❑ LOC
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MAGO03760404
<br />Deductible: $2,000 Comp. / $2,000
<br />04/30/2016
<br />04/30/2017
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />Collision
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />$2,000 Comp.
<br />/$2,000 Collision
<br />X
<br />P O RT AMAGE
<br />$
<br />X
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />_$
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE ❑
<br />OFFICER /MEMBER EXCLUDED?
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />--
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />A
<br />Professional Liability Insurance
<br />DPR 9803441
<br />04/30/2016
<br />04/30/2017
<br />Each Claim
<br />1,000,000
<br />Annual Aggregate
<br />$ 2,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Re: SARTC Parking Study
<br />The City of Santa Ana, its officers, employees, agents,volunteers, and representatives are added as additional insured to Commercial General Liability, Automobile Liability
<br />and /or Umbrella Liability only, but only with respect to liability arising out of the operations of the named insured.
<br />The Insurer will provide the Certificate Holder with thirty (30) days written notice of cancellation of the olicy.
<br />( �'rL�/ICVVk L7 F3Y. ' E UNIC; HE �ar:DIA (PG / OF �
<br />CERTIFICATE HOLDER CANCELLATION
<br />Page 1 of 1 @ 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE _
<br />20 Civic Center Plaza
<br />P.O. Box 1988
<br />CA
<br />t
<br />Santa Ana, 92702
<br />Page 1 of 1 @ 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|