Laserfiche WebLink
ACt'7)R®® CERTIFICATE OF LIABILITY INSURANCE <br />UA 12/1612EtMMOD YYY) <br />01 7 <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 pollcy(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 endorsement s . <br />PRODUCER <br />InterWast Insurance Services <br />License #0601094 <br />222 Court Street <br />CUNT <br />NAmaAc' Michelle Goodwin CIC, CISR, CPSR <br />PHONE FAx <br />, 831-635-2247 tac Nal, 831-638-6801 <br />EMAIL <br />-, m9oodv4n@)iwins.cam <br />Woodland CA 95695 <br />INSURERS AFFORDING COVERAGE NAIC# <br />INBURERA: LIbertV Mutual Fire Ins Co. 23035 <br />EACH OCCURRENCE $1000,000 <br />INSURED USHEA-i <br />Inc. <br />U,S.4Spri Springfield <br />25124 Springfield Ct., Ste 200 <br />INSURERS: Liberty Insurance Corporation 42404 <br />INSURER C: Safe National CasualtyCorp15106 <br />INSURER <br />Valencia CA 91355 <br />INSURER E <br />PRODUCTS -COMPIOPA09 P2,000,000 <br />NSURER F: <br />A <br />COVERAGES CERTIFICATE NUMBER: 1957039178 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 />ILTR <br />TYPE OF INSURANCE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />POLICYNUMSER <br />PMDD EFF <br />MMUO EXP <br />LIMITS <br />A <br />X COMMERCIAL GENERALLIASILITY <br />CLAIMS -MADE M OCCUR <br />Y <br />T02091450294W <br />911/2017 <br />9/12016 <br />EACH OCCURRENCE $1000,000 <br />_ <br />AMA _ <br />6 $1,000,990 <br />MED EXP(Amt one p.m.n) $10,000 <br />PERSONAL&ADV INJURY $1000,000 <br />GII AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JECLIjj <br />T 1171 LOC <br />OTHER: <br />GENERAL AGGREGATE <br />GENERAGGREGATE $2,000,000 <br />PRODUCTS -COMPIOPA09 P2,000,000 <br />$ <br />A <br />AUTOMOBILELIASILITY <br />X <br />X <br />ANYAUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />A$M91450294W7 <br />9/1/2017 <br />9/1/2018 <br />COMBINED SINGLE LIMIT <br />(Eae dd.M $ 1,000,00 <br />BODILY INJURY(P., p®rs n)u $ <br />BODILY INJURY Per.mtlent �$ <br />( ) <br />PROPERTYOAMAGE $ <br />era <br />B <br />X <br />UMBRELLA LIAS <br />EXCESS LIAR <br />X <br />OCCUR <br />CWIM$-MADE <br />TH7691460294D67 <br />9/112017 <br />9/1/2018 <br />EACH OCCURRENCE $25000000 <br />AGGREGATE $25000.000 <br />DED X RETENTION$ io opp <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />ANOFFIOMMEMBEREXCLUDED? YPROPRIETORfPARTNEWEXECUTNE ❑NIA <br />(Mmdatary In NH) <br />Hyx, tlaccdbe under <br />DESCRIPTION OFOPERATION balow <br />LDC4042721 <br />9/1r2017 <br />9/1@016 <br />H- <br />X P ?TR <br />T TE <br />E.L EACH ACCIDENT $20W009 <br />E.L. DISEASE -EA EMPLOYEE $2,000,W0 <br />E.L. DISEASE -POLICY LIMIT $2,EW 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, A881tional Remarks Sch.d.le, may be etEchml Nmore."..Is q.].d) <br />Re: 1619 East Edinger, Santa Ana, CA 02705 <br />CERTIFICATE HOLDER CANCELLATION 110 dava notice for non Davment <br />O 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />s �r�e t <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 />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />ORIZ <br />pI1THOR¢EOREPRE9EMATNE <br />'d {N^4a,7f4lL W.0 <br />O 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />s �r�e t <br />