|
WKEINCO-01 ROSEM
<br />CERTIFICATE OF LIABILITY INSURANCE DATE21512O,YYYY}
<br />12!512014
<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(les) 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 Ileu of such endorsement(s).
<br />PRODUCER License # OE67766
<br />NAME: CONTACT All Smith
<br />IDA Insurance Services
<br />4350 La Jolla Village Drive
<br />PHONE {619} 5?4-622Q tArc Na): (619) 574-6286
<br />Arc. Nd Ea
<br />--
<br />AodREss: AIi,Smith@ioausa.com
<br />Sate 900
<br />San Diego, CA 92122
<br />X No Co. Owned Autos
<br />INSURER(S) AFFORDING COVERAGE NAICB
<br />INSURERA:RLiinsurancecompany 13056
<br />_
<br />INsuREo
<br />INSURER B. Atlantic Spec laity insurance CoMpany
<br />27154
<br />INSURERC:
<br />WKE life.
<br />_
<br />INSURERD:
<br />400 N. Tustin Ave., 9275
<br />Santa Ana, CA 92705
<br />INSURERS:
<br />_ ...�
<br />PSB0001793 10111/2014 10/11/2015 BODILY INJURY(Per Parson) $
<br />INSURER F:
<br />ALI. OWNED SCHEDULED
<br />AUTOS AUTOS
<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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH TH IS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL IHE'i'ERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />PIPE OF INSURAINSR NCE
<br />INgp yyy POL)CY NUMBER M1DDfYYYY (MMlDO,YYYY) LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH Ou.URRENCE $ 2,000,00
<br />�CLAith MADE OCCUR
<br />X X SB0001793 1011112014 10M1i2015 pRE4AISEs Eam-vrrencet 3 1,tl00,000
<br />X Cant LlatS/$@V of int
<br />MED EXP {Myope persenj $ 10,000
<br />X No Co. Owned Autos
<br />PERSONAL A ADV INJURY $ 2,000,0040
<br />GFNI AG6RtE(EATC L. IM IT APPLIES PER
<br />GENERALAGGREGATE $ 4,000,00
<br />_ POLICY [�] P(RC- E LOC
<br />PRODUCTS- COMPJOPAGG $ 4,000,000
<br />OTHER:
<br />Deductible $ 0
<br />ALFrOMOBILE LIABILITY
<br />("acoldonry L IM IT $ 2,000,000
<br />AAnnAJ1O
<br />PSB0001793 10111/2014 10/11/2015 BODILY INJURY(Per Parson) $
<br />ALI. OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Pe1n1Id U) 3 ...........
<br />X X NUTO5 E0
<br />Pea $
<br />HIREDAU'1'OS _
<br />rlenl�MAGE
<br />$
<br />X'
<br />UMSRCLLAI.IAB X
<br />I OCCUR.
<br />EACH OCCURRENCE $ 2,000,000
<br />A
<br />ExCE@s CAB
<br />UCAINV-MA ESE0
<br />101694 10111!2014 1011112015 ASGRESATE $ 2,000,00
<br />B. . ....J�
<br />Ddq ...LCI LNTIDN$
<br />WORKERSCOMPENSATION
<br />N
<br />X STATUTE ER
<br />A
<br />ANDEMPLOORSTICIABILITY
<br />ANY PROPRIETOWPARTNEWEXECUTiVE YIN
<br />X PSWO001614 10111!2014 10/11/2015 EL.EACHACCIDENT $ 1,000,00
<br />OFFICERIMEMBFR EXCLU UED4
<br />(Mandatary In NH)
<br />EL. DISEASE- EA EMPLOYEE$ 1,000,000
<br />ITyea da9CYd0 Uptlal'
<br />DESCPIPTIt7N OF OPERATIONS below____
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />B
<br />Prof Liab/Clms Made
<br />DPL376714 10!1112014 1011112015 Per Claim 2,000,000
<br />B
<br />Ded.: $15k Elms Made
<br />DPL376714 10!1112094 10/1112015 Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftached if mare.,Pace Is Mquimd)
<br />Re: Fairview Ave Bridge at Santa Ana River
<br />City of Santa Ana, its officers, agents, volunteers and employees are Additional Insured's with respect to General Liability per the attached endorsement as
<br />Squired by written contract. Insurance is Primary and Non -Contributory. Waiver of Subrogation applies to General Liability and Workers' Compensation,
<br />0 Days Notice of Cancellation with 10 Days Notice for Nan -Payment of Premium in accordance with the policy provisions,
<br />Lo -703
<br />City of Santa Ana
<br />Attn: Mindy Ly
<br />20 Civic Center Plaza
<br />Ross Annex (M-36)
<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 />reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|