|
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 />A-2016-252
<br />E-MAIL t erkins@w oins,com
<br />ADDRESS' P s.....-
<br />INSURER(5� AFFORDING COVERAGE
<br />NAIC 0
<br />Manassas VA 20109
<br />INSURERA:Cincinnati ,Specialty Underwriters
<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 />DDL"ISUBR
<br />ILTR - q„ ... ..-
<br />TYPE OF INSURANCE +NS POLICY NUMBER
<br />...-
<br />PLICY EFF POLICY EXP
<br />O
<br />Ml DlYYYY ) ppryyyy LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE °6
<br />1,000,000
<br />A 1 CLAIMS -MADE � OCCUR(7AI1�
<br />c�<U Ok4_`NrFU � S
<br />PR� ��, �.�rrasnp�l..
<br />100,000
<br />�....
<br />X
<br />CSU0045016
<br />2/1.3/201.7 2/13/2018 ME-P;D EXP (Any one IparsonI... g
<br />1 , 000...
<br />...... ........�,,, .......-.. ..,.----
<br />PERSONAL A ADV INJURY S
<br />1,000,000
<br />GENI AGGREGATE LIMIT APPLIES PER:
<br />GEI'JERAI AGGREGATE I $
<br />2 , 000 , 000
<br />X POLICY� ........ � JECT �I Li"1Cn•
<br />j 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 />1 SCHEDUI...ED
<br />AUTOS I sAUTOS
<br />CSU0045016
<br />_. „{
<br />2/13/2017 2/1.3/201EEC1d':DIIYII�JURYQParxcccr.Rcacly) S
<br />-----......
<br />X NON -OWNED
<br />X
<br />G8
<br />ROPERTY DAMAGE
<br />_....... 4iIRED AUTOS AUTOS
<br />(Per...acr_ivSnPI
<br />1 �
<br />S
<br />I X UMBRELLA LIAB
<br />EACH OCCURRENCE $
<br />5 c 000_ 000
<br />A - EXCESS LIAB CLIUMS-MADE
<br />AGGREGATE 5
<br />5, 000 , 000
<br />..RETE.NTION ... .
<br />CSU 0068161
<br />; 2/13/2017 2/13/2018 101 .S
<br />..
<br />WORKERS COMPENSATION...
<br />AND EMPLOYERS LIABILITY YIN
<br />ANY PROPRIF"f01'-PARrNt• UEXPG;,Ul1VE
<br />„�"�7AT0.0VE!.....�I%10.
<br />"'
<br />�
<br />N / A
<br />L EACH ACCIDENT $ , ..
<br />- 500 � 000
<br />B OFFK,'E:1 ME�', IMIHE'.�R E'-XC I U DE: D?
<br />WCV6089388
<br />3/14/2016 7
<br />(Mandatory m NH)
<br />3/14/201 L. DISEASE E A E MPLOYPI-I S
<br />..
<br />.,. 500 000
<br />H yes, describe under
<br />- ,�..
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT S
<br />500 000
<br />C
<br />(Commercial Crime Coverage
<br />i
<br />42BDD 9940
<br />1/7/2017 1/7/2018 ... 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 />":1"1",_ rli I Ci'I
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORDORD CORPORATION. A s rerved.
<br />o INS025001401) ^'
<br />V: d . i M ,,
<br />
|