Laserfiche WebLink
CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM@DIYYYY) <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 Oertliloate holder to an A[ <br />the terms and Conditions of the policy, Certain <br />J. Gallagher & CO. <br />noe Brokers of CA, Inc. LIC 40726293 <br />Von Kerman, Suite 200 <br />CA 92612 <br />INSURED <br />1L INSURED, the policy(tes) must be endorsed, IF SUBROGATION IS WAIVED, subject to <br />may require an endorsement. A statement on this Certificate does not confer rights to the <br />COVE GE$ CERTIFICATE NUMBER: 2116095487 REVISION MUMBER: <br />THIS IS TO QERTIFY THAT THE POUOIES 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 />:LTR <br />TYPE OF IN SURANCEPOLIOMPP <br />DDLSUBR <br />b <br />POLICY NUMBER <br />MMIOD <br />POLI <br />MMIODA'YYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ❑ OCCUR <br />EACH OCCURRENCE <br />ea $ <br />MED EXP Anyone peraon$ <br />PERSONAL&ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY [—]YPe ❑ LOC <br />OTHER; <br />GENERAL AGGREGATE $ <br />PRODUCTS •COMP/OP ACG $ <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />W4 <br />AALULN� <br />qAUOT0O6WNBp <br />EU� 6."2 UM T $ <br />BODILY INJURY (Par person) $ <br />BODILY INJURY a <br />ccdent)T $ <br />__MG_ <br />PRRGPGR77Y M E <br />ant $ <br />UMBRELLA LIARQGCUR <br />EXCESS LIAB <br />CLAI Ma'MADE <br />EACHOCCURRENCE <br />AGGREGATE $ <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITYYIN <br />ANY PROPRIETRIPARTNEWEXECOTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory In NH) <br />II 969 d000rlbe andel <br />E64rRIPTIONOF OPERATIONS below <br />NIA <br />Y <br />W50502374502 <br />11/2016 <br />M112016 <br />X PER OTH� <br />STATUTE E <br />EJ.. EACHACCIDE1,T $1,000,000 <br />E.L DISEASE• EA EMPLOYE $1,000,000 <br />E.L. DISEASE -POLICY LIMIT 1,000000 <br />DESCRIPTION W OPERATIONS/ LOCATIONS I VEHICLES (AOORD 101, Addltlonal Ramadan Bahaduie, may be altnahed IF mora apace la requlrod) <br />Waiver of Subrogation applies to Certificate holder, as respects workers compensation policy, as per attached, <br />Waiver of subrogation applies to certificate holder on workers compensation liability policy, perthe attached form <br />WC990634800. <br />Re Work performed by the named insured ae required per written Contract with respects to City of Santa Ana <br />Cerdfloato holder continued; City of Santa Ana, Its officers, officials, employees, agepts,.Roti IulInteers� <br />lk�.e_ <br />CITY OF SANTA ANA <br />20 CIVIC CENTER IDLAZA <br />SANTA ANA CA 92701 USA <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 />AUTHORIZED <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />