|
N -yr
<br />HOUS&HA-01 SCURTIS
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM,iDDrYYYY)
<br />1 6124/2016
<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(ios) 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 lieu of such endorsement(s),
<br />PRODUCER License # OC36861
<br />CONTACT
<br />NAME: Stacy Guillen
<br />Inland Empire-Alliant Insurance Services, Inc.
<br />PHONEFAX
<br />(A/C, No, Ext): (909) 886-9861 (AIC,No): (909) 886-2013
<br />735 Carnegie Or Ste 200
<br />San Bernardino, CA 92408
<br />E-MAIL
<br />ADDRESS: SGuillen@alliant.com
<br />1,000,000
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />06/2412016 0612412017 DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $
<br />INSURER A: Ironshore Specialty Insurance Co 25445
<br />INSURED
<br />INSURER B: Nationwide Mutual Insurance Company 23787
<br />Houston & Harris P C S Inc
<br />RSUI Group 00000
<br />21831 Barton Road
<br />INSURER 0: State Compensation Insurance Fund of CA 35076
<br />Grand Terrace, CA 92313
<br />INSURER E; Landmark American Insurance Company 33138
<br />2,000,000
<br />INSURER F:
<br />rOVFRAC;FR C.FRTIFI('ATF N[IMRFR- RFVI-qION NIIMRFR-
<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
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRADDLSUBR
<br />_LTR TYPE OF kNS..URA.NCE .._... _.INSR._WVD POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />IMMiDDffYYYI (MMIDDI LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE S
<br />1,000,000
<br />CLAIMS -MADE X OCCUR X AGS0027604
<br />06/2412016 0612412017 DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $
<br />50,000
<br />MELS EXP (Any ane person) S
<br />5,000
<br />PERSONAL B. ADV INJURY S
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />POLICY X PRO-
<br />JECT LOC
<br />PRODUCTS - COMPIOP AGO $
<br />2,000,000
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />(Ea accident), $
<br />1,000,000
<br />B X ANY AUTO ACP3026645740
<br />0612412016 06/2412017 BODILY INJURY (P'er perscny S
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) S
<br />X X NON-OWNFD
<br />PROPERTY DAMAGE $
<br />HIRED AUTOS AUTOS
<br />(Per accident)
<br />....... . .....
<br />UMBRELLA I X OCCUR
<br />EACH OCCURRENCE
<br />4,000,000
<br />C X EXCESS LIAR CLAIMS -MADE NHA240514
<br />06/24/2016 0612412017 AGGREGATE S
<br />4,000,000
<br />DED X RETENTIONS 0
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS" LIABILITY Y/N
<br />STATUTE FIR
<br />D ANY PROPRIETOR/PARTNERJEXECUTIVE 9110513-15
<br />09101/2016 09101/2016 E.L. EACH ACCIDENT $
<br />i'000,000
<br />OFFICERIMEMBER EXCLUDED? NIA
<br />(Mandatory in NI
<br />E.L. DISEASE -EA EMPLOYEE $
<br />1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERA I"IONS bebw
<br />I DISEASE - POLICY LIMIT $
<br />1,000,000
<br />E Professional Liab LHR829681
<br />06124/2016 06124/2017 Agg/Each Claim Limit
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1111, Additional Remarks Schedule, may be attached if more space is required)
<br />Job: Operations pertaining to named insured for Certificate Holder.
<br />City of Santa Ana Additional Insured as respects to General Liability per the attached endorsements.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />Attn: Water Resources AP
<br />220 S Daisy Ave
<br />Santa Ana, CA 92703
<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 />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />M,
<br />N
<br />N
<br />IFIA
<br />
|