|
A� p® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />5/9/20116 Di
<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 endorsements .
<br />PRODUCER
<br />Crystal & Company
<br />CIBC Insurance Services LLC
<br />32 Old Slip
<br />CONTACT
<br />NAME, Jonathan Thomas
<br />PHONE FAX
<br />(AIC No Ext 415-946-7500 OI, 415-946-7550
<br />EbmpA,'L,,,.jonathan.thomas@crystalco.com
<br />INSURERS AFFORDING COVERAGE NAIL#
<br />New York NY 10005
<br />INSURERA:lndian Harbor Insurance Company 36940
<br />6024533045
<br />INSURED TTHOLD
<br />[NSURERB:Valley Fore Insurance Company 20508
<br />INSURER C: National Fire Insurance Company of 20478
<br />Palermo TT Holdings, Inc.
<br />9477 Waples, Suite 100
<br />San Diego CA 92121
<br />INSURER D: Continental Casualty Company 20443__
<br />CLAIMS -MADE 1X OCCUR
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 1768457215 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 INSURANCEADDL
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIVYYV
<br />POLICY EXP
<br />MMIDDIYYYY
<br />I LIMITS
<br />11
<br />X COMMERCIAL GENERAL LIABILITY
<br />6024533045
<br />5/1/2016
<br />15/1/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE 1X OCCUR
<br />DAMAGERENTED
<br />PREMISESS( RENTED
<br />)
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$15,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY [:] JECT PRO- [X] LOC
<br />PRODUCTS - COMP/OPAGG
<br />$2,000,000
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />6024533059
<br />5/1/2016
<br />5/1/2017
<br />COMBINEDSIN E MIT
<br />Ea accident
<br />$1,000,000
<br />_
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED X SCHEDULED
<br />UTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />NANYAUTO
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTYDAMAGE
<br />Per accident
<br />$
<br />C
<br />X
<br />UMBRELLA LIAB
<br />X_
<br />OCCUR
<br />6024533093
<br />5/1/2016
<br />5/1/2017
<br />EACH OCCURRENCE
<br />1$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE;
<br />DEO RETENTIONS
<br />_
<br />$
<br />I
<br />D
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />6024533076
<br />6024533062
<br />5/1/2016
<br />5/1/2016
<br />5/1/2017
<br />5/1/2017
<br />PER OTH-
<br />X I STATUTE ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E,L, EACH ACCIDENT
<br />$1,000,000
<br />OFFICER/MEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASEEAEMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />EL DISEASE -POLICY LIMIT
<br />--"-'-
<br />$1,000,000
<br />A
<br />Tech Professional Liab
<br />MTP903220001
<br />1 5/1/2016
<br />5/1/2017
<br />5,000,000 Each Claim
<br />Retroactive Date 1/1/92
<br />5,000,000 Aggregate
<br />Claims Made
<br />100,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana its officers, employees, agents, volunteers and representatives is included as Additional Insured as required by written
<br />contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability
<br />and Automobile Liability policies.
<br />F-�i
<br />
|