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MIDORI GARDENS (3)
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Last modified
6/15/2022 2:08:44 PM
Creation date
2/5/2018 1:23:51 PM
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Template:
Contracts
Company Name
MIDORI GARDENS
Contract #
A-2017-215-01
Agency
PARKS, RECREATION, & COMMUNITY SERVICES
Council Approval Date
8/15/2017
Expiration Date
1/31/2019
Destruction Year
2024
Notes
A-2017-215
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ACORa CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />`.� <br />06/01/2018 <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 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 />CONTACT Meredith MCCaleb CISR <br />NAME: <br />James G Parker Insurance Associates <br />PHONE (559)222-7722 Fax (559)222-1724 <br />A/C No Ext: AIC, No: <br />License #0554959 <br />E-MAIL mmocaleb@jgparker.com <br />ADDRESS: <br />P O Box 3947 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC N <br />Fresno CA 93650 <br />INSURER a: Financial Pacific ins Co <br />31453 <br />INSURED <br />INSURER B: State Compensation Ins Fund <br />35076 <br />Midori Gardens Inc <br />INSURER C: <br />3231 Main Street <br />INSURER D: <br />INSURER E : <br />Santa Ana CA 92707 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 18-19 GUBAM/C 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 <br />LTR <br />TYPE OF INSURANCE <br />AUDI. <br />INSR <br />SUUR <br />WVD <br />POLICYNUMBER <br />POLICY EFF <br />MMIDDIYI'YY <br />POLICY UP <br />MMIDDIYI'YY <br />LIMITS <br />X <br />COMMERCIAL GENERALLIABILITY <br />CLAIMS -MADE ❑X OCCUR <br />EACH OCCURRENCE <br />$ 1,000,000 <br />JAMAUIE <br />PREMISES Ea NIED <br />occurrence) <br />100,000 <br />$ <br />MED UP (Any one Person) <br />$ 5,000 <br />PERSONAL SADV INJURY <br />$ 1,000,000 <br />A <br />60505090 <br />06/01/2018 <br />06/01/2019 <br />GENTAGGREGATE <br />LIMITAPPLIES PER <br />POLICY ❑ PRO- ❑ <br />JECT LOC <br />GENERALAGGREGATE <br />g 2,000,000 <br />PRODUCTS-COMPIOPAGG <br />$ 2,000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ 1,000,000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANYAUTO <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />60505090 <br />06/01/2018 <br />06/01/2019 <br />BODILY INJURY (Per accident) <br />$ <br />X <br />HIRED NON -OWNED <br />AUTOS ONLY H AUTOSONLY <br />PROPERTY DAMAGE <br />Per accident <br />$. <br />8 <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED <br />I I RETENTION $ <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOWPARTNER/EXECUTIVE Y❑ <br />IM OFFICEREMBER EXCLUDED? <br />(Mandatory in NH) <br />If yes. describe under <br />DESCRIPTION OF OPERATIONS bekrx <br />NIA <br />9232562-2018 <br />06/01/2018 <br />06/01/2019 <br />XSTATUTE EORH <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 />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached if more space is required) <br />VvV Job: City of Santa Ana <br />The City of Santa Ana, its officers, agents and employees are included as additional insureds as per attached endorsement CG 2 `11Z1P1. <br />111 a <br />City of Santa Ana Parks, Recreation & Community <br />Arm Silvia Cuevas <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 />AI � li" `� <br />©1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />
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