Laserfiche WebLink
Click here to clear Form Click here to Send Form <br />ACORD. CERTIFICATE OF LIABILITY INSURANCE <br />DATE <br />03/22/2018 vvv) <br />03/22/2018 <br />PRODUCER <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />LIN ASSOCIATES INSURANCE AGENCY <br />24705 NARBONNE AVE, #200 <br />LOMITA, CA 90717 <br />POLICY EXPIRATION <br />DATE MM/DD/YY <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />INSURERA THE HARTFORD 29459 <br />CENTURY STRUCTURAL ENGINEERING CO. INC. <br />24719 NARBONNE AVE <br />LOMITA, CA 90717 <br />INSURERB. <br />INSURERC. <br />INSURER D'. <br />INSU RERP <br />0 <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. <br />INSR <br />LTR <br />ADOL <br />NSR <br />FOR EVIDENCE OF COVERAGE ONLY <br />PLANNING AND BUILDING AGENCY <br />CITY OF SANTA ANA <br />ATTN: MARIO ESPINDOLA <br />POLICY NUMBER <br />POLICYEFFECTIVE <br />DATE MM/DD/YY <br />POLICY EXPIRATION <br />DATE MM/DD/YY <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIALGENERAL LIABILITY <br />CLAIMS MADE Lj OCCUR <br />0 <br />EACH OCCURRENCE <br />$ <br />0 <br />PREMISES Ed occurence <br />$ <br />MED EXP(Anyoneperson) <br />$ <br />0 <br />PERSONAL&ADVINJURY <br />$ <br />D <br />GENERALAGGREGATE <br />$ <br />GENLAGGREGATE LIMITAPPLIES PER <br />POLICY M PRO- M LOC <br />0 <br />PRODUCTS-COMP/OPAGG <br />$ <br />o <br />El <br />AUTOMOBILE <br />LIABILITY <br />ANYAUTO <br />ALL OWNEDAULOS <br />SCH EDU LED AUTOS <br />HIREDAUTOS <br />NON -OWNED AUTOS <br />COMBINED SINGLE LIMIT <br />(Ea acci de nt) <br />$ <br />D <br />r <br />I ) <br />I LYper <br />(Per sonn) <br />so <br />$ D <br />D <br />BODILY raccid nt) <br />(Peracadent) <br />$ <br />D <br />0 <br />� <br />D <br />PROPERTYDAMAGE <br />(Peracadent) <br />$ <br />GARAGE LIABILITY <br />AUTO <br />rl IOTHERTHAN <br />D <br />AUTOONLY-EAACCIDENT <br />$ <br />EAAGO <br />AUTO ONLY <br />$ <br />EXCESS/UMBRELLA LIABILITY <br />OCCUR CLAIMSMADE <br />DEDUCTIBLE <br />RETENTION $ <br />0 <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />0 <br />0 <br />$ <br />$ <br />$ <br />A <br />WORKERS COMPENSATION AND <br />EMP LOYERS'LIAB <br />ANY PROPRIETOR/PARTPARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />Hyes describe under <br />SPECIAL PROVISIONS below <br />157WECDW3167 <br />01/18/2018 <br />01/18/2019 <br />0 TORYLPM ITS OER <br />EL EACH ACCIDENT <br />$ 1000O <br />,,OO <br />O <br />D <br />0 <br />ELDISEASE-EAEMPLOYEE <br />$ 1,000,000 <br />0 <br />ELDISEASE -POLICY LIMIT <br />1 $ 1,000,000 <br />OTHER <br />D <br />D D <br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2001108) \ VORD CORPORATION 1988 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30' DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDE5AAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />IMPOSE NO OBLIGATION OR-1 <br />LIAB Y"OF AN ., PON THE INSURER, ITS AGENTS OR <br />REPRESENT IVES. <br />FOR EVIDENCE OF COVERAGE ONLY <br />PLANNING AND BUILDING AGENCY <br />CITY OF SANTA ANA <br />ATTN: MARIO ESPINDOLA <br />AUTHORIZED REPRESENTATIVE — <br />LIN ASS CIATES IN _ - -E C" <br />ACORD 25 (2001108) \ VORD CORPORATION 1988 <br />