|
AeC RhP CERTIFICATE OF LIABILITY INSURANCE
<br />'
<br />DATE(MM/DD/YYYY)
<br />1
<br />llk
<br />6/16/2016
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER Venbrook Insurance Services CA Lic OD80832
<br />6320 Canoga Avenue 12th Floor
<br />Woodland Hills, CA 91367
<br />NAME:
<br />PHONE FAX
<br />/o o E t • 818-598-8900 Alc Not: 818_598-8910
<br />_
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC#
<br />www.venbrook.com _
<br />INSURERA: Hartford Accident and Idemnity Company
<br />22357
<br />_ _
<br />INSURED
<br />Overland l C &Cutler Inc.
<br />3750 Schaufeufele Avenue,
<br />Suite 150
<br />Long Beach CA 90808
<br />INSURER B : Hartford Fire Insurance Company
<br />19682
<br />INSURERC: Hartford Casualty Insurance CompanyCompgDy
<br />29424
<br />INSURERD: Sentinel Insurance Company, Limited
<br />11000
<br />INSURERE: Twin City Fire Insurance Company
<br />29459
<br />INSURER F : Western World Insurance Company�13196
<br />�w�►ra�en�na �r�rauarr����01�11g1_��S�ei LL/e4i , wl efUlV/mil\�d1�LLler�i�
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />J=
<br />SUBR
<br />WVD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />�/
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1:21 OCCUR
<br />✓
<br />72UUNTR7859
<br />6/1/2016
<br />6/1/2017
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMA PREMISES E)�sLo�cctIDnce)_—_S
<br />300,000
<br />✓
<br />MED EXP (Any one person)
<br />—
<br />$ 10,000
<br />$10,000 BI&PD Ded.
<br />Per Claim
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ✓❑ EI° ❑✓ LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENT
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />Em . Ben. Liab. Occ.
<br />$ 1,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />72UUNTR7859
<br />6/1/2016
<br />6/1/2017
<br />/EOacccidentSINGLELIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)OWNED
<br />ANY AUTO
<br />1�:/Comp
<br />SCHEDULEDar
<br />ONLY ✓ AUTOS
<br />( )BODILY INJURY Pid
<br />accentAUTOS
<br />$HIRED
<br />NON -OWNED
<br />ONLY ✓ AUTOS ONLY
<br />PROPERTYDAMAGEAUTOS
<br />__(Peraccidgat___.,
<br />$
<br />1 000 ✓ Coll $1 000
<br />1
<br />1
<br />C
<br />`/
<br />UMBRELLAIJAB
<br />H
<br />OCCUR
<br />72RHUTR7849
<br />6/1/2016
<br />6/1/2017
<br />EACH OCCURRENCE
<br />$ 2,000000
<br />AGGREGATE
<br />$ 2,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />$
<br />D
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />AN`fPROPRIETOR/PARTNER/EXECUTIVE ❑
<br />OF F ICER/M EM HER EXCLUDED?
<br />NIA
<br />72WEDQ4300
<br />6/1/2016
<br />6/1/2017
<br />✓ SEATUTE °RH
<br />__.._.....------.--..---_._..._.....---......_..
<br />E.L EACH ACCIDENT
<br />----- —'-----
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT I
<br />$ 1,000,000
<br />F
<br />Professional Liab.
<br />BRL0011689
<br />6/1/2016
<br />6/1/2017
<br />$2,000,000 Each Claim
<br />Claims Made
<br />$2,000,000 Aggregate
<br />Retro Date: 6/30/03
<br />$50,000 Deductible
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />RE: Property Acquisition, Relocation & Management Services Agreement. A-2011-055-01, A-2015-162, A-2015-165
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as additional insured on a
<br />primary & non-contribUtory basis where required by written contract. Subject to policy teens, conditions and exclusions.
<br />*10 Days Notice of Cancellation for Non -Payment of Premium, 30 Days All Others. ✓
<br />r
<br />REVIEWED WED BY: �'r � � �r ..._..-._ t UNl(t l it R EAA (PG OF )
<br />t Cr%l lr'lVM I C r1ULIJCR I,H fV IrCLLH I IUIV
<br />City of Santa Ana
<br />P.O. Box 1988
<br />20 Civic Center Plaza (M-36)
<br />Santa Ana CA 92702
<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 REPRESENTATIVE
<br />(WH) Wendy Filice C/
<br />(0 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />30446384 100000019 1 16-17 GL Ail WC Me PROF I (WH) Linda Doyc.— 16/16/2016 2:46:16 PM (POT) I Page L of 5
<br />
|