|
AC klk_j " CERTIFICATE OF LIABILITY INSURANCE ®AZi7i2o1 )
<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 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
<br />`'"""" Thomas Perkins
<br />Welch, Graham & Ogden Ins., Inc.
<br />PHONE (703) 530-1300 FAX (703)530-9994
<br />OJCG Nz.EXD ,SIG _Nok
<br />7723 Ashton Avenue
<br />E-MAIL t erkins@w 01nS, COm
<br />ADDRESS P g
<br />A-2016-252
<br />-
<br />INSURER(8j AFFORDING COVERAGE
<br />NAIC p
<br />Manassas VA 20109
<br />INSURERA:Cincinnati ,Specialty Pp4erwri,ters
<br />1303,7
<br />INSURED
<br />INSURER B Accident Fund General
<br />12304
<br />The Olson Group Ltd
<br />INSURER C :The Hartford
<br />300 N Washington Street
<br />INSURERD:
<br />Suite 600
<br />INSURER E
<br />Alexandria VA 22314
<br />INSURER F.
<br />COVERAGES CERTIFICATE NUMBER:CL172718782 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
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE
<br />BEEN REDUCED BY PAID CLAIMS.
<br />DDLISUBR
<br />ILTR - q„ ... ..-
<br />TYPE OF INSURANCE +NS POLICY NUMBER
<br />...-
<br />O
<br />PLICY EFF POLICY EXP
<br />Ml DlYYYY ) ppryyyy LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />1,000,000
<br />A 1 CLAIMS -MADE � OCCUR(7AI1�
<br />c�<U Ok4_`NTFU � S
<br />PR� ��, �.�rrasnp�l..
<br />100,000
<br />X
<br />CSU0045016
<br />2/1.3/201.7 2/13/2018 ME D EXP QAny one I'imaunI g
<br />1,000
<br />...... ........�,,, .......-.. ..,.
<br />PERSONAL ADV INJURY S
<br />1 000 000
<br />GENI AGGREGATE LIMIT APPLIES PER:
<br />GEI'JERAI AGGREGATE I $
<br />----
<br />2,000,000
<br />X POLICY........ JECT �I Li"1Cn•
<br />I PRODUCTS - COMP/OP AGG S
<br />.- ...- ...-...-
<br />2,000,000
<br />OTHEF2
<br />S
<br />AUTOMOBILE LIABILITY
<br />'.. COMBINED SINGLE LIMIT S
<br />1,000,000
<br />----
<br />ANY
<br />I�ODILY IIVLi JUI2Y (Per avrsorry S
<br />A I .. ALL OWNAUTO
<br />D SCHEDUI
<br />AUTOS I sAUTOS
<br />CSU0045016
<br />_. „{
<br />2/13/2017 2/1.3/201 8 Q1C1d':DIIYII�JURYQParacccr.Rcacly) S
<br />--- --
<br />X NON -OWNED
<br />G ROPERTY DAMAGE
<br />_....... HIRED AUTOSX AUTOS
<br />4 (Per...acr_identl
<br />1 �
<br />S
<br />I X UMBRELLA LIAB
<br />EACH OCCI IRRENCE $
<br />5 c 000_ 000
<br />A - EXCESS LIAB E
<br />CE.fiIMS-MAD....,
<br />AGGREGATE 5
<br />5, 000 , 000
<br />.. RETENTION.
<br />CSU 0068161
<br />12/13/2017 2/13/2018 1.. .... .. S ..
<br />....
<br />WORKERS COMPENSATION
<br />01 MQ
<br />X" 4T0.0VL.,,,,,,,.77
<br />AND EMPLOYERS LIABILITY YIN
<br />ANY PROPR1Er01'-PARrNt•
<br />ER
<br />UEXEG;,Ul1VE 1
<br />N/A
<br />L EACH ACCIDENT
<br />B 00FK,'E:1J1MlEMIHER EXQ:,IA.IQ'DD':,D?
<br />WCV6089388
<br />3/14/2016 7 �.
<br />(Mandatory in NH)
<br />3/14/201 L. DISEASE EA EMPLOYPI-I S
<br />.. ,.
<br />.,. 500 000
<br />H es, describe under
<br />,�..„.- �m ®.
<br />.
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT S
<br />500,000
<br />C
<br />(Commercial Crime Coverage
<br />i42BDD
<br />9940
<br />1/7/20171/7/2018 ... w.
<br />500,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Certificate holder, it's officers, agents, and employees are named as Additional Insured in regards to
<br />General Liability per written contract. Endorsement attached.
<br />10 day written notice of cancellation for non payment of premium.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Purchasing Department ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />„_.,.
<br />":1"1.ot111Qi'
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORDORDCORPORATIO s ro
<br />erved.
<br />INS025001401)
<br />
|