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APPLI-2 OP ID: RA
<br />A�ORD CERTIFICATE OF LIABILITY INSURANCE
<br />D06/26ATE /2018 )
<br />06/26/2018
<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 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 />Stockdale Ins (Bakersfield)
<br />LICENSE#OC26131
<br />CONTACT
<br />-NAME, FAX FAX
<br />A/c No Ell: 661-327-3321 A/c No: 661-327-3490
<br />PO Box 10269
<br />Bakersfield, CA 93389-0269
<br />E-MAIL
<br />ADDRESS:
<br />220 S Daisy Ave (M-85)
<br />Andy Naworski
<br />INSURER(S) AFFORDING COVERAGE NAIC It
<br />INSURER A: Federal Insurance Company 20281
<br />INSURED Applied Technology Group Inc.
<br />INSURER B: 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 />INSURER E:
<br />3602-52-22 WCE
<br />INSURER F:
<br />07/0112019
<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. 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYYI
<br />POLICY EXP
<br />(MMIDD/YYYYI
<br />LIMITS
<br />and Representatives
<br />GENERAL LIABILITY
<br />220 S Daisy Ave (M-85)
<br />�cq
<br />Santa Ana CA 92703
<br />EACH OCCURRENCE $ 1,000,00
<br />PREMISES (Ea occurrence $ 1,000,00
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX I OCCUR
<br />Y
<br />3602-52-22 WCE
<br />07/01/2018
<br />07/0112019
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL B ADV INJURY $ 1,000,00
<br />X Contractual
<br />GENERAL AGGREGATE $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,00
<br />POLICY X PRO LOC
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1,000,00
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />A
<br />X ANY AUTO
<br />(18)735846-39
<br />07/01/2018
<br />07/0112019
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS HAUTOS
<br />PROPERTY DAMAGE $
<br />PER ACCIDENT
<br />X
<br />UMBRELLA LIABX
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,00
<br />AGGREGATE $ 6,000,00
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />798948-22
<br />07/01/2018
<br />07/01/2019
<br />DED RETENTION$
<br />FOLLOWING $ FOR
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />N/A
<br />SA503611601
<br />03/22/2018
<br />03/22/2019
<br />X WC STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,00
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />C
<br />Equipment Floater
<br />SML93032865
<br />07/01/2018
<br />07/01/2019
<br />Towers 1,580,500
<br />D
<br />Professional
<br />EKS3237775
<br />11/19/2017
<br />11/19/2018
<br />Per Claim 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named as additional insured as required by written
<br />contract per the attached blanket endorsements. This insurance is primary
<br />and non-contributory.
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<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTAAN
<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 its Officers
<br />Employees, Agents, Volunteers
<br />and Representatives
<br />AUTHORIZED REPRESENTATIVE
<br />220 S Daisy Ave (M-85)
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<br />Santa Ana CA 92703
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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