Laserfiche WebLink
a DATE (M IDD/YYYY) <br />AC"RV <br />CERTIFICATE OF LIABILITY INSURANCE <br />7124/2017 <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 />11IP _O_RTANT: 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 />thiis certificate does not confer rights to the certificate holder in lieu of such endorsement(s . <br />PRODUCER NA_[CONTAGI <br />ME: Erika Sokolik <br />Arthur T Gallagher & Co, JAIL, <br />H. ... ........... . . .. . FAX <br />Insurance Brokers of CA Inc,LIC #0726293 JAIC, No, Ext): 8181- 5 314 - 3 5 5 8 (AIF, No): 818,316-0990 <br />21820 Burbank Blvd. Suite 175 ADDRESS - <br />Erika Sokolik0ajg,corn <br />Woodland Hills CA 91367 UYSURER(S) AFFORDING COVERAGE NAIC # <br />INSURER A: Insurance Company-of,the West.. 27847 <br />INSURED INSURER B.- <br />Downey Vendors <br />INSURER C <br />. . .. .... . ..... . ........ .. <br />6814 Suva Street <br />Bell Gardens, CA 90201 INSURER DI <br />INSURER E <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER- 1359967359 REVISION NUMBER: <br />11-IIS IS TO CERTIFY THAT THE _F151 _IC_1ESOF —INS—U—RANCE LISTED BELOW I LAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDIN(, ANY REQUIREMENT, "TERM OR CONDITI(,-)N OF ANY CONTRACT OR OTHER DOCUMEN IF WiTI-I RESPECT TO WHICH THIS <br />CER1IFICAFE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCFZIBFD HEREIN IS SUBJFC"1 TO ALL THE TERMS, <br />EXCLUSUNS AND CONDI11ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAO CLAIMS. <br />iNSR ADEL SUBRPOLICYEFF 1 P0uCYEXP <br />LTR TYPE OF INSURANCE MMIDDI f INSO MVD I _POLICY NUMBER LIMI[TS <br />COMMERCIAL GENERAL LIABILITY <br />F.ACIi OCCURRENCE I <br />DTO R AMAGE _D E`NTF <br />CLAIMS -MADE OCCUR PREMISES (Ea ccqur,re_(rc,e) $ <br />ME FXP (Any one person) $ <br />PERSONAL & ADV INJUR'v <br />GEN'I_ At LIMIT APPLIES PI.-.R, GENERAL AGGREGATE <br />POLICY LOC PRODUCIS -COMP;OPAGG <br />AUTOMOBILE LIABILITY <br />ANY AUTO r3Gr79p.Y INJURY (Per he song � 9 <br />OWNED SCHEDULED <br />AUTOS ONLY AUTO <br />U TOS POINLY INJURY (Per =jderit) <br />HIRED NON -OWNED PROPLATY DAMAGL <br />J1OS ONLY AUTOS ONLY $ <br />accidwit) <br />UMBRELLA LIABI iOCCUR E,ACH OCCURRENCE <br />j EXCESS LIAB CLAIMS MhDF AGGREGATE <br />DE� <br />L _iRLH <br />NTION $ $ <br />T­­ 172612011 R <br />A !WORKERS COMPENSATION WVE503733300 7/26�2018 X ! <br />ST 1"WE ER <br />AND EMPLOYERS' LIABILITY YINJ A <br />ANY PROPRIETOMPARTNEMEXECUTWE <br />OFFICER/MEMBI-P FXCLUDED7 NIA rA EACI-I ACCIDENT S1,000,000 <br />'(Mandatory in NH) <br />FILr DISEASE. - EA EMPLOYEE $1,000,000 <br />. ... ...... .. ..... .. ... ...... <br />I It yes, de�crlbe under <br />T) 9CMPTION OF OPERATIONS belt E L. DISEASE - POLICY LIMIT $1,000,000 <br />ne <br />DESCRIPTION OF OPERATIONS I LOCATION$ IVEHICLES (ACORD 101, Additionaf Rernavits Schadule, rnay be attached if rnora spai; <br />? <br />Evidence of insurance only. <br />1A <br />M\a <br />\�Ol <br />�Qcls <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Aria THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 00c Center 8th Floor ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE <br />cc) 1988-2015 ACORD CORPORATION, All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />