W.A. RASIC CONSTRUCTION COMPANY, INC. (2)

Home Browse Search

of • I -II- 2Z8 -aI �1 A�� CERTIFICATE OF LIABILITY INSURANCE D4/17 /2019v) 4/17/2019 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(ies) 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 endorsements . PRODUCER CONTACT NAME: Commercial Associates Insurance 1594 N. Batavia Street Orange, CA 92867 PHONE (719)524-4949 FAX (Tld)52d-d9d0 A/C No: EMAIL ADDRESS: INSURERB AFFORDINGCOVERAGE NAIC7t INSURER A:Travelers Indemnit Co. of CT 25682 INSURED W.A. Rasic Construction Co., Inc. INSURER B:Travelers pro Cas CO of America 25674 INSURER C: 4150 Long Beach Blvd. INSURER D: Long Beach, CA 90807 INSURER E: INSURER F: nvnrccn. 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, INSR LTR I TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF I, POLICY EXP WMIDEINYWI, LIMITS X COMMERCIAL GENERAL LIgBILITY I EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE 1XX1 OCCUR DAMAGE T RENTED PREMISES Ea occurrence $ 300,000 X DT22-00-8670x 47-WT-19 5/1/2019 5/1/2020 MED EXP(Any one person) $ 10,000 - — PERSONAL B ADV INJURY I$ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRO- I GENERAL AGGREGATE $ 4, 000,000 POLICY L� JECT U LOB PRODUCTS - COMP/OP AGO $ 4,000,000 OTHER. $ AUTOMOBILE LIABILITY i COMBINEDt SINGLE LIMIT Lacciden$ 2,000, 000 B X ANY AUTO BODILY INJURY (Per person) $ AOI SCHEDULED _ AUTOS AUTOS DT-810-8670X247-TIL-19 5 1 2019 // 5/1/ 2020 BODILY INJURY (Par accident) ,$ _. HIREDAUTOS NUTOSWNED PROPERTY DAMAGE $ �L, accident Uninsured motorist combined $ UMBRELLA LIAB Ll OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION -PER Ul AND EMPLOYERR/PARTNERI Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE _ STATUTE EERH 1 ! \ / E� OFFICER/MEMBER EXCLUDED? (Mandatory in N/A I-T` r..�'' V I�� E.L. EACH ACCIDENT $ / yes, describe under and 1 B.L. DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below jJ p E.L. DISEASE LIMIT -POLICY $ 42 PAGE I OF- , ---------------- DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Umore space is required) Re: Operations usual to the named insured - Master Service Agreement - On -call emergency sewer and water systems repair services contract City of Santa Ana, its officers, employees, agents, volunteers and representatives are added as additional insured including primary wording where required by written contract as respects general liability per attached CGD246 4/19 & CGT100 2/19. 30 days notice of cancellation except 10 days for non-payment. rcOnerrwTc un, nce City of Santa Ana 220 S. Daisy Ave., M-85 P.O. Box 1988 Santa Ana, CA 92703 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 8-2014 A RD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are regis red rk CORD Ii INS025 (201401)