|
GRAFPRO-01 URE
<br />'4 CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 02119/201 YYJ
<br />02(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(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER LloensB # 0757776 CONTACT
<br />Concord, CA • HUB International Insurance Services Inc. PHONE _ _— _
<br />2300 Clayton Rd. (AIC, N1,o, Ext): (925) 609.65.00_. FAX Ndl:(925) 609.6550
<br />Concord, CA 94520 ADTRI Bft
<br />INSURED
<br />Graffiti Protective Coatings, Inc.
<br />419 North Larchmont, #264
<br />Los Angeles, CA 90004
<br />_ INSURER(S) AFFORDING COVERAGE. NAIC#
<br />INSURER A: Evanston Insurance Company _. 35378
<br />INSURERS Liberty Mutual Fire Insurance Company ,23035
<br />INSURER C
<br />INSURERD;. __-
<br />COVFRAr.9FS rFDTIFIPATc uweoce.
<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 _. _.. ADDL SUER
<br />LTR TYPE OPO4CY EfF POLICY UP
<br />OF POLICY NUMBER LIMITS
<br />A X''II. - COMMERCIAL GENERAL UABWTY Y 1000000
<br />• EACH OCCURRENCE S _ _
<br />CLAIMS -MADE X_ OCCUR _ X MKLVSENVIO0735 02117/2018 02117/2019 DDAMAGESfTORENTED al... $ 1 1.00,000
<br />MED Ex_P(Any one person] $ 5,000
<br />------------ ---
<br />PERSONAL &AOV INJURY 3 1,00000
<br />_-
<br />GEN'LPOAGGREGAICY TE LIMIT APPLIES PER: '�, GENERAL AGGREGATE $ 2,000,000
<br />_., J@@pp. �--,
<br />ECT _ LOC PRODUCTS - COMP'OP AGG $ 2,000,000
<br />OTHER'
<br />B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
<br />XANY AUTO 1,000,000
<br />_ X X AS2Z91466837018 01/01(2018 01101(2019 BODILY INJURY (Per Pe,se„I ,$
<br />OWNED _--- SCHEDULED J - - -
<br />AUTOS ONLY AUTOS
<br />p� �µo� BODILY INJURY (Per eccti0eng,3
<br />AUTOS ONLY AUTOS ON' PROPERTY DAMAGE
<br />(Per acatlenQ _ $
<br />UMBRELLA LIAR OCCUR EACH OCCURRENCE $
<br />EXCESS LNa ,CLAIMS -MADE
<br />_. _. AGGREGATE_ $
<br />DEO :RETENTION$
<br />B WORKERS COMPENSAMN X PER OTH.
<br />ANO EMPLOYERS LIABILITY STATUTE Eft
<br />ANY PROPRIE70RPARTNERIEXECUTIVE YYN, NIA X WC2Z91466837028 01101/2018 01/01(2019 - 1,000000
<br />OFFICE qh!�q EXCLUDED? E L EACH ACCIDENT $
<br />(Mantlatory o NH) - -
<br />Ifyes,tlescilmemer EL DISEASE -EA EMPLOYEE_¢ 1'000,000
<br />DESCRIPTION OF OPERATIONS below _ EL.DISEASE-POLICYLIMIT 1,000,000
<br />A Pollution Liability MKLV5ENV100735 02/17/2018 02/17/2019 Each Condition 1,000,000
<br />DESCRIPTION Of OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remake Schedule, mey W aeachod If mom apace is requeed)
<br />RE: Service Contract
<br />The City of Santa Ana, Its officers, agents, employees and representatives, as additional Insured as respects to General Liability per attached CG 20 37 0704
<br />and additional Insured in respects to Auto Liability per attached AC 84 07 07 13. Waiver of Subrogation applies to Auto Liability per AC 84 07 0713 and
<br />Workers Compensation per attached WC 04 03 06 (ed. 4-84), all as required by written contract.
<br />AP'..d a. Ib' /
<br />Pe&1of14
<br />}1-18
<br />The 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 />------ V 19dd-ZU1b ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|