Laserfiche WebLink
` CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM /DDM'YY) <br />,,`b® <br />V <br />08/26/2016 <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 <br />CONTACT <br />-NAME; GABBY SANTIAGO <br />StateFarer► Greg Lauck, State Farm Insurance <br />(PA J&NE 9169789110 FAX 9169789122 <br />Ex[: AIC No <br />950 Fulton Ave STE 175 <br />IL <br />ADDRESS: GABBY @GREGLAUCK.NET <br />EACH OCCURRENCE <br />INSURERS AFFORDING COVERAGE <br />NAIL# <br />PREMISES ETORENT 0 <br />PREMISES EaNTED occurrence) <br />INSURER A: State Farm Mutual Automobile Insurance Company <br />25178 <br />Sacramento Ca 95825 <br />INSURED <br />INSURER B: State Farm Fire and Casualty Company <br />25143 <br />HOERTSCH TRAINING & CONSULTING LLC <br />INSURER C: State Farm General Insurance Company <br />25151 <br />INSURER D: <br />GENERAL AGGREGATE <br />5150 FAIR OAKS BLVD STE 101 <br />INSURER E : <br />$ 2,000,000 <br />CARMICHAEL CA 95608 <br />INSURER F: <br />$ <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />5UBR <br />POLICY NUMBER <br />MMIDDITYF <br />MMLDDYEYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE El OCCUR <br />Y <br />90- CM- S743 -8 <br />07/23/2016 <br />07/23/2017 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />PREMISES ETORENT 0 <br />PREMISES EaNTED occurrence) <br />$ 300,000 <br />MED EXP(Any one person ) <br />$ 5,000 <br />PERSONAL &ADV INJURY <br />$ <br />GENU <br />AGGREGATE LIMIT APPLIES PER: <br />PRO <br />POLICY PRO- [::] LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2.000,000 <br />PRODUCTS- COMPIOPAGG <br />$ 2,000,000 <br />$ <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Y <br />2841893- D16 -55B <br />04/17/2016 <br />10/16/2016 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Par person) <br />$ 250,000 <br />BODILY INJURY (Per accident) <br />$ 500,000 <br />PROPERTY DAMAGE <br />Per accident <br />$ 100,000 <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICERIMEMBER EXCLUDED? � <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />I PER OTH- <br />STATUTE ER <br />E.L. EACH ACCT DENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />City of Santa Ana <br />20 Civic Center Plaza M -16 / PO BOX 1988 <br />Santa Ana <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 REPRESENTATI -V7E�� <br />CA 92702 Lyre i"7 . <br />© 1988.2015 ACORD CORPQFWIO <br />ACORD 25 (2016103) The ACORD name and logo are registered marks If, fjlRD ' �y jj ��rr <br />