|
-.1-01 u' 0a -v
<br />APPLI.2 OP ID: KC
<br />ACORO'DATE(MMIDDJYYYY)
<br />1141 CERTIFICATE OF LIABILITY INSURANCE
<br />o4H112018
<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 CONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDIT10NAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />LICENSE #OCtockdale Ins26131 Bakersfleld)
<br />PO BOX 10269
<br />Bakersfield, CA 93389-0269
<br />CONTACT
<br />NAME:
<br />acoa E :661343-1546 A1C No: 6613273490
<br />EMAIL
<br />ADDRESS:
<br />GENERAL LIABILITY
<br />Andy Naworski
<br />INSURERS) AFFORDING COVERAGE MAIC r
<br />INSURER A: Federal lnsuranceCom pany 20281
<br />INSURED Applied Technology Group Inc.
<br />INSURERS: Insurance Co. of The West 27847
<br />4440 Easton Drive
<br />Bakersfield, CA 93309
<br />INSURERC:AGCS Marine Insurance Company 22837
<br />INSURER D:Scottsdale Insurance Company 41297
<br />NSURER E :
<br />602-52-22 VICE
<br />'1111111F:
<br />071012018
<br />COVERAGES CERTIFICATE NUMBER: 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. NOTW ITHSTAN DING 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />I
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD
<br />P LIC YEXP
<br />MM
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,060,00
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OOCCUR
<br />Y
<br />602-52-22 VICE
<br />07/01/2017
<br />071012018
<br />MAS �N
<br />-DVAX
<br />PREMISESEa occurrence $ 1,000,00
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL &ADV INJURY $ 1,000,00
<br />X Contractual
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER.
<br />PRODUCTS-COMP/OP AGG $ 2,000,00
<br />17 POLICY X PRS LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,0
<br />Ea accident $
<br />BODILY INJURY (Per Derson) $
<br />A
<br />'X ANY AUTO
<br />17)73584639
<br />07/01/2017
<br />07101/2019
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIREDAUTOS AUTOS
<br />BODILY INJURY (Per accitlentl $
<br />PROPERTY DAMAGE $
<br />PER ACCIDENT
<br />X UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />AGGREGATE $ 5,000,00
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />798946-22
<br />07/01/2017
<br />07/01/2016
<br />DED RETENTION$
<br />FOLLOWING $ FOR
<br />B
<br />WORKERS COMPENSATON
<br />AND EMPLOYERS'LIABILITY
<br />ANY PROPRIETORPARTNEPoFAECUTIVE Y�
<br />Rd
<br />OFFICEREMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />SA503611601
<br />03/22/2016
<br />03/22/2019
<br />X WC STATU. OTH-
<br />T RY T
<br />E L. EACH ACCIDENT $ 1,000,00
<br />EL. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes. describeunder
<br />DESCRIPTI ON OF OPERATIONS below
<br />E. L. DISEASEPOLICYLIMIT $ 1,000,000
<br />C
<br />D
<br />Equipment Floater
<br />'Professional
<br />SM L93032865
<br />EKS3237775
<br />07/0112017
<br />11/19/2017
<br />07/01/2018
<br />11/19/2018
<br />Towers 1,531,00
<br />Per Claim 1,000,00
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mora space Is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named as additional insured as required written
<br />contractper the attached blanket endorsements. This insurancece a
<br />is primry , JJ
<br />anddnon-contributory.
<br />/'
<br />P4�2, i /-7 u
<br />SANTAAN
<br />City of Santa Ana its Officers
<br />Employees, Agents, Volunteers
<br />and Representatives
<br />220 S Daisy Ave (M-85)
<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 />legQ
<br />OO 1988-2010
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
|