|
CALIFE11 OP ID: WS
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />°A08/1812015"'
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
<br />09116/2015
<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(les) 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 HOD of such endorsement(s).
<br />PRODUCER
<br />Elkins Jones Insurance Agency
<br />CONTACT Walt $tOYCh
<br />NAME: _ _ ---------------
<br />Inc
<br />PHONE 310-_2079796 FA%
<br />. Ex L- INC No): 310.207.5337
<br />12100 Wllshire Blvd., #900
<br />E- AIL _....._.... _
<br />Los Angeles, CA 90025
<br />-ADDRESS
<br />Waif $tOfCrl
<br />- -
<br />WELL SJAFFORDING COVERAGE NAIL 9
<br />NSLRSRA Ironshore Specialty Ins Co
<br />Barricade Rentals
<br />INSURED 1550
<br />INSURERS; Allied Group 42579
<br />_79
<br />East
<br />1550 East St. Gertrude
<br />--------...._.------._.__ .........---_---_—_._.
<br />Santa Ana, CA 92705
<br />INSURER c:National Union Fire Ins. Co.119445
<br />LX�Aggper project
<br />INSURER D State Compensation Ins. Fund
<br />IHeUK5RE:
<br />2000,000
<br />INSURER F
<br />UOVER.AUtS CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS "f0 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
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY PAID CLAIMS.
<br />INSR' —"- 3UBR'
<br />LTR TYPE OFINSURANCE VO POLICY NUMBER
<br />-I' POLICY EFF '-"POLICYE%P
<br />11M OO riV MMI00 YY LIMITS
<br />,GENERAL LIgBILITY
<br />A X X X
<br />AGS0047502
<br />EACH OCCURRENCE _ $ 1,000,000
<br />ANfAOETo BENIS(Ea.o
<br />CGMMERCIAL GENERAL LIABILITY
<br />07/01/2016
<br />07101/2016 r, S
<br />50,000
<br />_
<br />CLAIMS MACE C OCCUR
<br />l
<br />MED E5E (Any one Pam or)
<br />MEO EXP (Any one person) 1
<br />5,000
<br />.._—
<br />..__
<br />l
<br />(PERSONAL &ADV INJURY $
<br />i'000,000
<br />LX�Aggper project
<br />GENERAL AGGREGATE $
<br />2000,000
<br />GEPILAGGR LIMIT APPLIES PER
<br />rPRODUCTS- COM?IOP AGO 3
<br />2,000,000
<br />—1
<br />I X I PUucy PRc°r LOG
<br />_
<br />iEmp Ben. a
<br />1,000,000
<br />AUTOMOBILE LIABILITY
<br />!
<br />COMBINEDS NG IMIT
<br />.(Ee aaaldenll S.
<br />1000,000
<br />B X ANY AUTO X_
<br />ACPSA3006736836
<br />10710112015�07/0112015
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED -:
<br />IO
<br />_ AUTOS
<br />'---
<br />BODILY INJURY IF .... ooenU $
<br />---
<br />NON-OVOUD '„
<br />HIRED AUTOS AUTOS !
<br />- -
<br />'-PROPERTY DAMAGE ---
<br />-; (PERACCIDENT2_ - $
<br />S
<br />X
<br />OCCURE%CESS
<br />UMBRELLA LIARt-i-
<br />EACHOCCURRENCE $
<br />5000,000
<br />C XI
<br />LIAR -
<br />CLAIMSMAOEI X
<br />BE047721473
<br />071011201507101120161
<br />AGGREGATE
<br />DECI X RETENTION$ nil, L
<br />'.$
<br />I
<br />WORKERS COMPENSATION ''.I
<br />AND EMPLOYERS' LIABILITY Y).N j
<br />D
<br />WC STATU- 0TH-,
<br />X.TOR[IIJMIT6I IER,__.
<br />APIYPROPRIE7ORIPARTNERIEXECUTIVE X '006360615
<br />07/0112015 0710112018 EL E $
<br />ACHACOIDENT
<br />1,000,000
<br />OFFICERIMEMBER EXCLUDED? ❑IN/A'
<br />_(Mandalo-ylnNH)
<br />_
<br />r _ _
<br />! E.L DISEASE EA EMPLOYEE S
<br />-
<br />1,000,000
<br />- If Yea, describe under
<br />—
<br />-
<br />OESCRIP'CONOFOPERATIONSbelory
<br />IE. L, DISEASE. - POLICY LIMITa
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS ILCCADDNSIVEHICIES(AtUmh ACORD lei, Additional Romm-Im Schedule,
<br />holder, its
<br />If mare apace In ramilrmn
<br />certificate officers, agents, and employee
<br />are named as
<br />additional insureds per CG20370413 Automobile Al; ACOI
<br />subrogation per CG24000509
<br />01 03 01. Waiver �5
<br />J
<br />CITYSA3
<br />City of Santa Ana
<br />PRCSA
<br />20 Civic Center Plaza - M23
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL ME DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AU/THHOO.R/IZEDD REPRESENTATIVE
<br />©1966-2010 ACORD CnRPnRATHOM All Hnh+e .—.... M
<br />ADORE 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
|