|
A4C"Ra CERTIFICATE OF LIABILITY INSURANCE
<br />�D
<br />.....�
<br />Y)
<br />OAT 0/201 /201
<br />12/15
<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 CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ; .,I11 I ' I} — P "'",9 tit_
<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 a opsoun A statlernent on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). ` tt YY
<br />PRODUCER
<br />Frank Crystal& Co., Inc.
<br />dba Crystal &Company
<br />32 Old Slip
<br />la;KJonathan Thomas
<br />PHONE
<br />.415-946-7500 FAX .415-946-7550
<br />E-MAIL .certificates: donna.smith@crystalco.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC p
<br />New York NY 10005
<br />INSURER A: Federal Insurance Company
<br />20281
<br />INSURED TTHOLD
<br />INSURERB:Chubb Indemnity Insurance Company
<br />12777
<br />Palermo TT Holdings, Inc.
<br />INSURERC:Indian Harbor Insurance Company
<br />36940
<br />9477 Waples, Suite 100
<br />San Diego CA 92121
<br />INSURER 0:
<br />INSURER E
<br />DAMAGE TO RENTED
<br />PREMISES Ea occunence
<br />IN USER F:
<br />MED EXP (Any one person)
<br />COVERAGES CERTIFICATE NUMBER: 1649929855 RFVIRION NIIIURFR•
<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 />MTRR
<br />TYPE OF INSURANCE
<br />ADDLSUBR
<br />NSD
<br />MO
<br />POLICY NUMBER
<br />POLICY
<br />9EYVY
<br />MM�O�MXVY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LI ABILITY
<br />36027336
<br />5/1/2015
<br />5/1/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE IX OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occunence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL It ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO � LOC
<br />ECT
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />73588515
<br />5/1/2015
<br />5/1/2016
<br />MBINED IN LE
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Par person)
<br />$
<br />X
<br />ANY AUTO
<br />X
<br />AUTOSNED X SCHEDULED
<br />AUT
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />NONWNED
<br />0S
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />79896819
<br />5/1/2015
<br />5/1/2016
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY VIN
<br />71747856
<br />5/1/2015
<br />5/1/2016PER
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANY
<br />OFFICERRv EM ER EXCLUDED?ECUTIVE F]
<br />NIA
<br />E.L. DISEASE - EA EMPLOYE
<br />$1,000,000
<br />(Mandatory In NH)
<br />fps, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />1 $1,000,000
<br />C
<br />Tech Professional Liab
<br />MTP0032200
<br />5/1/2015
<br />5/1/2016
<br />5,000,000 Each Claim
<br />Retroactive Date 1992
<br />Claims Made
<br />5,000,000 Aggregate
<br />100,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is req ul red)
<br />City of Santa Ana its officers, employees, agents, volunteers and representatives is included as Additional Insured as required by written
<br />contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability
<br />and Automobile Liability policies.
<br />CERTIFICATE HOLDER CANCELLATION
<br />@ 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 />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />60 Civic Center Plaza
<br />Santa Ana, CA 92701-0000
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|