|
ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />2/27/2019
<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 />HUB International Insurance Services Inc.
<br />License #0757776
<br />3636 American River Drive, Suite 200
<br />Sacramento CA 95864
<br />CONTACT
<br />NAME: RDciD LeDn
<br />PHONE FAX No : 916-993-7234
<br />AICC_ Ext : 916-480-4134
<br />E-MAIL ss: Rocio.Leon@hubinternational.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Greenwich Insurance Company
<br />22322
<br />INSURED WAREDIS-02
<br />Ware Disposal Inc.
<br />P.O. Box 1318
<br />INSURER B : Westchester Surplus Lines Insurance Co.
<br />10172
<br />INSURERC: Alaska National Insurance Company
<br />38733
<br />INSURER D : Evanston Insurance Company
<br />35378
<br />Santa Ana CA 92702 2
<br />r1 / 7— ')/
<br />V `✓ 7�
<br />INSURER E:
<br />INSURER F :
<br />./
<br />COVERAGES CERTIFICATE NUMBER: 19RRRinR3d P=11lc1nn1 nn IRMM=M.
<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 />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />MM DDY/YYYY
<br />MM/DD//YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />GEC3000730-04
<br />2/28/2019
<br />2/28/2020
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />%(
<br />DAMAGE TO RENTED
<br />CLAIMS -MADE OCCUR
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />$1,000 PD Ded.
<br />Per Occurrence
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />POLICY IA jE LOC
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />AECO04538604
<br />2/28/2019
<br />2/28/2020
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000.000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />S
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />Per accident
<br />BI/PD Deductible
<br />$ 10,000
<br />B
<br />UMBRELLA LIAB
<br />N
<br />OCCUR
<br />G46863306002
<br />2/28/2019
<br />2/28/2020
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />18H WS 05450
<br />8/1 /2018
<br />8/1 /2019
<br />XPER
<br />AND EMPLOYERS' LIABILITY YIN
<br />STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$ $1,000,000
<br />ANY PROPRIETOR
<br />OFFICER/MEMBER/ EXCLUDED? ECUTIVE
<br />N / A
<br />E.L. DISEASE - EA EMPLOYEd
<br />$ $1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. �DISEASE- PUDGY LIMIT
<br />-
<br />-$ $1,000,000
<br />DESCRIPTVN,I_gF OPERATIONS '„a!�w
<br />-
<br />D
<br />Environmental Impairment
<br />Liability/CPL
<br />17CPLOWE00598
<br />2/28/2017
<br />2/28/2020
<br />Each Loss 1,000,000
<br />Aggregate 1,000,000
<br />Deductible 10,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />(General Liability Per Project Aggregate applies per written contract)
<br />RE: Work performed by the insured for certificate holder per written contract
<br />Additional Insured: City of Santa Ana; its officers, employees, agents, volunteers and representative
<br />Forms: CG2010 0413, CG2037 0413, IX1405 0910, XIL431 0605
<br />dZ 6
<br />CITY OF SANTA ANA PUBLIC WORKS AGENCY
<br />PO BOX 1988 M-21
<br />SANTA ANA CA 92701
<br />jyfilVl.CLLHI IVIV
<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 />'e�reralc__
<br />U 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|