|
ACORO® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DDYYYY)
<br />1 12/19/2018
<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 endorsement(s).
<br />PRODUCER LICENSE NO. 0637431
<br />NAME, PATRICK MCRAE
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1265 N. MANASSERO ST. SUITE 303
<br />A/CC No, Ext: (714) 779 6999 ac No: (714) 779-6903
<br />E-MAIL p.mcrae@sbcglobal.net
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />ANAHEIM HILLS, CA 92807
<br />INSURERA: FIRST MERCURY INSURANCE CO.
<br />10657
<br />INSURED
<br />INSURERS: INSURANCE COMPANY OF THE WEST
<br />27847
<br />wsURERC: NATIONAL GENERAL INSURANCE
<br />23728
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />INSURERD: TOPA INSURANCE COMPANY
<br />18034
<br />5454 DIAZ STREET
<br />INSURERE: GREAT AMERICAN INSURANCE CO.
<br />16691
<br />IRWINDALE CA 91706
<br />INSURERF:
<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 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 LTR
<br />TYPE OF INSURANCE
<br />J=
<br />SU D
<br />POLICY NUMBER
<br />MMIDDPOLICYYYYY
<br />MMIDD YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ❑X OCCUR
<br />XCU
<br />X
<br />X
<br />WACGL0000007866201
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />06/03/2018
<br />06/03/2019
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY �X PRO- LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />EBL
<br />$ 1,000,000
<br />OTHER:
<br />I
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />2005675448
<br />11 /05/201811
<br />/05/2019
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$ -
<br />ANY AUTO
<br />ALL OWNED AUTOS X SCHEDULED
<br />AUTOS
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />E
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />TUE 2572052 00
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />6/03/2018
<br />06/03/2019
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />DED RETENTION$ 0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N
<br />OFFICER/MEMBER(Mandatory in NH) EXCLUDED?
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N / A
<br />x
<br />WVE 5030354-03
<br />06/03/2018
<br />06/03/2019
<br />X STATUTE OERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />PROPERTY &
<br />CONTRACTORS
<br />PC 6600421-02
<br />$1,000 DEDUCTIBLE
<br />COV. INCL. THEFT
<br />05/10/2018
<br />05/10/2019
<br />$4g uidings
<br />$38585,78780 BPP
<br />$410,968 Property off Premises
<br />$300 $300:000000 I/EE BI/EE BPP
<br />LeaseEQUIPMENT
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more s ace Is regulred)
<br />THE CITY OF SANTA ANA, ALONG WITH THEIR OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH
<br />RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED.
<br />RE: Agreement #A-2017-172
<br />CTWN: 3196 REVIEWED BY: EUNICE HEREDIA (PG `OFG )
<br />t,r-K I Irlt A I t MULUttC UANGtLLA I IUN
<br />City of Santa Ana
<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 />91988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
|