|
IM
<br />AC" © CERTIFICATE OF LIABILITY INSURANCE D9/26/2016YI
<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 endorsementfs).
<br />PRODUCER
<br />Insurance Solutions
<br />License #0746539
<br />33302 Valle Rd, Suite 200
<br />San Juan Capistrano CA 92675
<br />INSURED
<br />Professional Sport: Field Maintenance Inc
<br />23 Emerald Gin
<br />(949)348-7400
<br />>inH@ins-solutions.com
<br />COVERAGES CERTIFICATE NUMRFRrl 6-17 All RPWARTIN NI IMRFR,
<br />(949)349-2373
<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
<br />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 BEEN REDUCED BY PAID CLAIMS,
<br />ILTR� TYPE OF INSURANCE ................. ADID SUER POLICY Err POLICY EKE
<br />POLICY NUMBER MMIDD1YYYY MMIDD/YYYY
<br />__- ����....._..1.....
<br />LIMITS
<br />._._._
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE ',$
<br />1,000,000
<br />A CLAIMS MADE'X'. OCCUR
<br />_.
<br />'.,
<br />OAMAGES.LHaENTED --
<br />PREMISES_{Es omurrenee) __$
<br />500,000
<br />_
<br />BKO57465702
<br />'.. 10/1/2UL6 10/1/2017
<br />MEO EXP (Any one person) $
<br />15, 000
<br />..._..... _____...
<br />PERSONAL&ACV INJURY $
<br />11000,000
<br />GENIE AGGREGATE LIMIT APPLIES PER:
<br />G CNERAL AGGREGATE $
<br />2, c00, 000
<br />X ..POLICY ,. JECT LED
<br />PRODUCTS. COMPIOE AGG $
<br />2, 000, 000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />(Ea accident)_
<br />1,000,000
<br />_
<br />B X ',. ANY AUTO
<br />BODILY INJURY (Per person) S
<br />ALL AHED _;SCHEDULED AW3A377777
<br />......._.. AUTO AUTOS
<br />8/26/2016 8/26/2017
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED -
<br />HIRED AUTOS
<br />._.., AUTOS
<br />,tParaaldent).,,
<br />PROPERTY DAMAGE-"-
<br />uninsured motorist combined $
<br />300,000
<br />X !. UMBRELLA LIAS -_X .00CUR
<br />EACHOCCURRENCF I$
<br />2,000,000
<br />C EXCESS LIAS CLAIMS.MADE
<br />AGGREGATE $
<br />2,000, 000
<br />DEC RETENTION$ 'ESM7465702
<br />''. 10/1/2016 10/1/2017
<br />'.$
<br />WORKERS COMPENSATION
<br />X PER 0 H-
<br />AND EMPLOYERS' LIABILITY YIN
<br />, STATUTE _ ER-"."_„-_
<br />.._.__.._...__. „
<br />ANY PROPRIETORIEXCLUDRIEXECUTIVE --
<br />NIA
<br />EL EACH ACCIDENT $
<br />1 COO, 000
<br />D -- 1620476-2016
<br />-- --
<br />MandaOFFICERri,InBREXCWDE07
<br />I14816d ory in NH)
<br />2/26/2016 2/26/2017
<br />E L DISEASE - EA EMPLOYEE $
<br />1 , 000, 000
<br />If yyes describe uneer
<br />-
<br />"-
<br />' 'ASS
<br />-0ESCRIPTIONOFOPERA'rIONSbelow
<br />-"
<br />E.L. DISEASE-POLICV LIMIT '$
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, a Cached Ir moreapace is require
<br />The City of Santa Ana, it's officers, employees,
<br />agents, and represents.
<br />are included as additional
<br />insured per the attached endorsement.
<br />(714)647-6944 SCUEVAS@SANTA-ANA.ORG
<br />City of Santa Ana
<br />Attn: Purchasing Department
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />Alessaadra/PETERS -4s, ..._��
<br />91988.2014 ACORD CORPORATION. All rights
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INSO281Pn14m,
<br />
|