MDG ASSOCIATES, INC. 3 - 2016 - Laserfiche WebLink

Home Browse Search

A `�'� bia CERTIFICATE OF LIABILITY INSURANCE DATE(MMI2015Y) n/11/zo15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED; subject to the forms and Conditions of the policy; certain policies may require an endorsement. A statement On this certificate does not confer rights to the Certificate holder in lieu of such - endorsements); PRODUCER POWACT Tani Larsen NAME: Mutual Insurance Agency CA License If 0574041 AHGNEO Ex :- (628) 795 -9595 AQ 0: (62fi)793 -78fi9 ADDRESS: larsent@mutualinsagay, Coca 30 N. Marengo Ave INSURERS AFFORDINOAOVERAQE NAICW Pasadena CA 91101 INSURERA:American States Ins Co 19704 INSURED INSURER I3: INSURERC: MDG Associates, Ina. .'I.D722 Arrow Route, Suite 822 INSURER O; $ 200,000 INSURERS: MED EXP (Any one person) $ 10,000 Rancho Cucamonga CA 91730 1 INSURER FI X COVERAGES CERTIPICATE NUMBER:2015 -2016 GL .REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Or NSU RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED.NAMED ABOVE. FOR THE POLICY PERIOD INDICATED', NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN -, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES, LIMITS SHOWN MAY HAVE BEEN. REDUCED BY PAID CLAIMS. ILTR TYPE OF IN$URANCE 2DQ POLICV NUMEER POLICY EFF MMIDDIYYYY POLICYEXP MMIDDIY YyYI LIMITS A X COMMERCIAL OENERAL LIASILITY CLAIMS -MADE X❑OCCUR EAGH,OCCURRENCE $ 1,000,000 PREMISES. ES OCCUITenOa $ 200,000 MED EXP (Any one person) $ 10,000 X OICIOD917010 7/112016 7/112016 PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMIT ARPLIES PER P'L'Y E'oo El -0c GENERAL AGGREGATE $ 2,000,000 OEN'L X PRODUCTS- COMP /OP AGG $ 2,000,000 Emplo�se'Renefite $ 1,000,000 'OTHER -, AUTOMOSII:E LIABILITY ld I7G ELIMIT Ed oco mr $ 1,000,000 %� X BOgILY INJURY(Perperson) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS S E HIREDAUT X' AUT X O1C270073540 711/2015 7/1/2016 BODILY INJURY (Per accident) $ cD G Per acl ant) $ UMBRELLA LIAO X 'OCCUR EACH OCCURRENCE $ 4 000 00.0 AGGRRGATE' $ A 000 000 A X EXCESS CLAIMS -MADE DED X RETENTION'$ 10,600 X I OIXS14991700 7/112016 71.1/2016 WORKERS COMPENSATION AND 9hIPLtlYEnS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFIGER/MEMBER EXCLUDED? (Mandatary In NH) If yes, dendbe under DESCRIPTION OF OPERATIONS' below NIA OTH� 'STATUTE ER EL EAOH'AGGIDENT $ E. L. DISEASE - EA EMPLONEF $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS 1 VEHICLES IACORD 101, AddRlonal Remarks Schedule,: may be attaehod If more spacers required) The City of Santa Ana, its officers, employees, agents and Volunteers are named Additional Insured, but only as respects the Insureds Operations as it relates to their Signed Contract in regards to the CDHG Administration - Consulting Services per Form CG8674 attached. .Primary Insurance and Transfer of Rights of Recovery' Against Others is included per Form CG0001 attached.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Terri Eggers, Senior Mgmt. Analyst AUTHORIZED REPRESENTATIVE 20 .Civic Center Plaza Santa Ana, CA 92701 Howard Wooton /TLL 01988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks.of ACORD I NS025 (20140 1)