|
A�RiJs CERTIFICATE OF LIABILITY INSURANCE
<br />5 -DATE (Mmu n'YYY>
<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 />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA, Inc. LIC #0726293
<br />18201 Von Karmen, Suite 200
<br />CONTACT
<br />�JeM : Arthur J. Gallagher &Company
<br />PNONE . g49- 349 -9800 FAx .9 ?9- 349 -9962
<br />F�o
<br />EMAIL
<br />DRESS
<br />INSURERS AFFORDING COVERAGE
<br />NAIC4
<br />Irvine CA 92612
<br />INSURER A:Valley Forge Insurance Corn any
<br />20508
<br />_
<br />INSURED ARCHDES -04
<br />INSURER s:Continental Casualty Company
<br />20443
<br />Architectural Design & Signs, Inc.
<br />INSURERC:Starr Indemnity & Liability Company
<br />38318
<br />1160 Rail Road St
<br />Corona, CA 92882
<br />INSUaeao:
<br />Iff AMA E R NTE
<br />PREMISES (Ea occurrence)
<br />INSURER E
<br />X
<br />INSURER F:
<br />$15,000
<br />COVERAGES CERTIFICATE NUMBER: 1229892863 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 />Lm
<br />rypE OF INSURANCE
<br />INSD
<br />VIVO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYI'YV
<br />POLICY EXP
<br />MMIDDIYYVY
<br />LIMITS
<br />A
<br />X
<br />CO MMERCIALGENERAL LIABILITY.
<br />Y
<br />Y
<br />5095058447
<br />5/5/2016
<br />515/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE ❑ OCCUR
<br />C
<br />Iff AMA E R NTE
<br />PREMISES (Ea occurrence)
<br />$100,000
<br />X
<br />MED EXP (Any one person)
<br />$15,000
<br />XCU INCL
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER'
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY [X7] jEpT [::] LOC
<br />PRODUCTS - COMP /OP AGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />6024411463
<br />5/5/2016
<br />5/5/2017
<br />Ea acct LD
<br />$1,000,000
<br />BODILY INJURY (Per parson)
<br />$
<br />ANY AUTO
<br />AILL OWNED AUTOSULED
<br />BODILY INJURY(Peraccident)
<br />$
<br />Ix
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />jeer accitlen0
<br />$
<br />COMP /COLL DIED
<br />$1,000
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />6024471480
<br />5/5/2016
<br />5/5/2017
<br />EACH OCCURRENCE
<br />$10,000,000__
<br />I
<br />AGGREGATE
<br />$10,000,000
<br />X
<br />EXCESS LIAB
<br />GIAIMS-MADE
<br />DED X I RETENTION$ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />1000002170
<br />5/5/2016
<br />5/5/2017
<br />X I STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANY PROPRIETOR/PARTNER /EXECUTIVE
<br />OPFICERIMEMSER EXCLUDED? ❑NIA
<br />E.L. DISEASE - EAEMPLOYE
<br />00,
<br />$1,0000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE- POLICYLIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The certificate holder(s) is /are named additional insured /primary non - contributory /general aggregate applies as respects
<br />to the general liability policy, per the attached forms CNA74705115. The certificate holders) is /are named additional insured/ aiver of
<br />subrogation applies, as respects to the auto liability policy, per the attached form CNA63359.
<br />RE: City Wayflnding Signs.
<br />Certificate Holders) continued: The City of Santa Ana, its officers, employees, agents and volunteers.
<br />CERTIFICATE HOLDER CANCELLATION 111 0
<br />City of Santa Ana, M -93
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92702
<br />USA
<br />AUTHORIZED RE-PRESENTATIVE
<br />l `°-
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|