IPC FUEL DISTRIBUTION, INC. - 2016

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IPCUS-1 OP ID: JG ,4c®�zv CERTIFICATE OF LIABILITY INSURANCE `r...�� DAT2 1 11/22//22/2001616 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Marsh JCS Risk & Ins. Services CA License# 0768427 CONTACT Grace Mizushima NAME: WC fk ,.1:213-624-5555 A"� Nn:213-346-5930 EMAIL ADDRESS: 777 S. Figueroa St. 24th Floor Los Angeles, CA 90017 Grace Mizushima INSURERS AFFORDING COVERAGE NAIC N INSURERA:Tokio Marine America Ins., Co. 10945 MED EXP (Any One person) $ INSURED IPC (USA) Inc. 4 Hutton Centre Dr., Ste 700 Santa Ana, CA 92707 INSURER B: INSURER C: GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ INSURER D INSURER E AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIREDAUTOS AUTOS INSURER F: CnVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE INSURANCE DL UBR p POLICY NUMBER POLICVEFF MMIDDIVYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY ADE OCCUR AUTHORIZED REPRESENTATIVE Santa Ana, CA 927011 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any One person) $ nC�LAIMS-MADE PERSONAL&ADV INJURY $ LIMIT APPLIES PER: PRO- ❑LOC JECT GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIREDAUTOS AUTOS COMBINED SINGLE LIMIT Ea Me $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Per accident UMDBELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ IS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, tlescribe under DESCRIPTION OF OPERATIONS below NIA WC6407119.02 12/31/2015 12/31/2016 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E. L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Evidence of WC Insurance. CERTIFICATE HOLDER CANCELLATION ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Attn: Purchasing Dept 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 927011 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD