MS + MEGT - 2017 - Laserfiche WebLink

Home Browse Search

A� O® CERTIFICATE OF LIABILITY INSURANCE DATE A 2IMMIDD1�) 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(tes) must have ADDITIONAL INSURED provisions or 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 endorsement(s). PRODUCER CONTACT KIM FORSYTH NAME: StateFarin KIM FORSYTH INSURANCE AGENCY, INC IPA NE 949-366-0320 F� No : 949-366-3322 802 AVENIDA TALEGA, SUITE 106 ®� E-MAIL SS: kim@kimforsyth.com INSURE S AFFORDING COVERAGE NAIC# SAN CLEMENTE, CA 92673 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURERB: State Farm Mutual Automobile Insurance Company 25178 MONICA SIMPSON A LANDSCAPE INSURER C : ARCHITECT CORPORATION INSURER D : 305 N COAST HWY STE T INSURER E: LAGUNA BEACH CA 92651-1681 INSURER F: COVERAGES CERTIFICATE NUMBER: RFVISIAN NIIMRFR- 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. INS LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD LIMITS A COMMERCIALGENERALLIABILITY CLAIMS -MADE M OCCUR Y 92-CO-K584-0 04/04/2017 04/04/2018 EACHOCCURRENCE S 1,000,000 PREMISES LEA Occurrence $ 300,000 MED EXP (Any One person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT C LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS-COMP/OPAGG S 2.000,000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 448 6576-008-75C 09/08/2017 03/08/2018 E° COMBINED SINGLE LIMIT S 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DASMAGE per accident ---- --- $ S UMBRELLA LIAB Ul EXCESS L6 OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION S S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I ( PER OTH- STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE -EA EMPLOYEE S E.L. DISEASE- POLICY LIMIT S i I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) REVIEWED BY: ni EUNICE HEREDtA (PG OF ) City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' > ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016