HomeMy WebLinkAboutFPL AND ASSOCIATES INC. 2 -2005
-1CORU I CERTIFICATE OF LIABILITY INSURANCE Date (mmlckllyy)
10/28/2005
Producer Darlene Martinez THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
Wood Gutmann & Bogart Insurance Brokers THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
15901 Red Hill Ave., uite 100 COVERAGE AFFORDED BY THE POLICIES BELOW.
Tustin CA 92780 JRE~S ~oVE
714 505.7000 INSURER U. S. Fidelity & Guaranty
www.wgbib.com
License No. 0679263 A
INSURER SI. Paul Travelers
Insured A-()..oo5-1d. IS B
INSURER Continental Casualty
FPL and Associates, Inc. C
10 Corporate Park, Ste 310 INSURER National liability & Fire
Irvine CA 92606 D
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY POLICY
INSR EFFECTIVE EXPIRATION
LTR TYPE Of INSURANCE POLICY NUMBER DATE DATE LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ I
"' ~ :J'7MERCIAl GENERAL L1AB BK01883824 9/1/2005 9/1/2006 FIRE DAMAGE (Any 1 rife) $
CLAIMS MADE [lJOCCUR MED EXP (An one 0' $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'l AGG LIMIT APPLIES PER PRQOUCTS-COMPIOP AGG $
tlPOLlCY nPROJECT nLOC $
~ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO BK01883824 9/1/2005 9/1/2006 $ 1 000 00
All OWNED AUTOS BODIL V INJURY
SCHEDULED AUTOS (PerpersOIl) $
HIRED AUTOS ..t_:" P AS TO ':'Oi<.l\-l BODILY INJURY
NON-OWNED AUTOS (Peracclclent) $
'/ 2) t.,I f /.c- PROPERTY DAMAGE
(Peraccloollt) $
~ARAGE lIABIUTY t/' AUTO ONLY - EA ACCIDENT $
ANY AUTO -. . " "Cyj! OTHER THAN EAACC S
., ;.' ,h.....- AUTO ONLY:
AGG $ ~~
EXCESS LIABILITY . 9/1/2005"'~' -9/1/2006 EACH OCCURRENCE $
3 !tJOCCUR 0 CLAIMS MADE BK01883824 AGGREGATE $
$
R~EDUCTIBlE $
RETENTION S $
WORKERS' COMPENSATION & -'" I STATUTORY LIMIT THER =-
EMPLOYERS' LIABILITY EL EACH ACCIDENT $
) 0100008167051 5/1/2005 5/1/2006 EL DISEASE - EA EMPLOYEE $
EL DISEASE - POLICY LIMIT $
IC Professional L1ab MCA114132312 9/1/2005 9/1/2006 $5,000,000
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder is named as Additional Insured per attached CUBF 26 09 09 03 along with Primary wording, as their
interest may appear.
THIS CERTIFICATE SUPERCEDES ALL OTHERS PREVIOUSLY ISSUED.
CERTIFICATE HOLDER CANCELLATION
xxx SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Santa Ana Public Works Agcy EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
.....3..O......DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRE-
20 Civic Center Plaza, M43 SENTATIVES. *10 Davs for Non.Pavment of Premium
Santa Ana CA 92701 AUTHORIZED
REPRESENTATIVE
~ ~. ~-
James E. Gutmann
ACORD 25-5 (7/97) cnI8ted at WWw.eeart.DNlINE.com o ACORD CORPORATION 1988
ACORD 25-S (7/97)
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION 1$ WAIVED, subject to the terms and conditions of the policy. certain poHcies may
require an endorsement. A statement on this certificate does not conter rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative 01 producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
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created at www.eCertsONlINE.com
Named Insurod: FPL and Associates, Inc.
hrq Nu&Uer. BK01883824
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UABIUTV COIJEAAGEPAIIT,
I. Th. IallllWln~ rapl_ the hi paragroph of
IICJJlllI U. WIlD IIAIIUIIwn.1;
Howm" na JlIIIIII1 0' mvllllZlll.n II In Inllnd
v.!lllreslBllG the ;tIII~uct or ItIY Mont... pool
1lI~ joint Ylntlir" Uflhld lilbmty
_pooyor tnlll1hatialllll'htMn" I N~
InullO In 1111 LlIblll1y CIlWi1GI Pon
DKlllltion., m. ",",",,011 doeI not _10~.
la, 1<'1' ponl~~ In ..... put or pINnI
"IlMomtd joint v.dlJnI', ... I' 11111 Illllllln or
orQllllllllIll1 Is ollllllWlSl III "'And 1IIlCfo,
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z. Thllallowing i. added to IED1l0N .. WHO . AN
1NIUIlED.1.:
,_ Dr 0Ip0i00tIM ........ Iy
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add II .. 1n.1Il8lI ui1dtr 11111 lialllllty
CII'ImV' PIlI In . wrItloJl 00'_ or
Igl'II..1II1I1ol ia IIlOlII be"".. and in oHtct
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lIImIgI' IIIICWS Dr .,. un.. lhIl __
thl 'pII1OIIOllnjU/Y' or..dvor!IoInt lnJ\ly" II
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penan'I or lIgInlllllolfllllbllllV IIIIlIlll out
of 'yo.. wort/' lor lIwI PO"" ot
O'iOOl_on.
lal YOII' IIIIII\geIICII: II
OIl TIle IIIlIIIIlIIlCl 01' IIIV1I1lr po_ or
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'pIfIIIIlOlinjlly'or'odwr1ilioginJlI'I'
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Igl'llmll'll. _pt far liability fa,
dofIlIOa the! SllI:h psnIlII or
tfIIIIlllltlOll would 11M In ... ob......
oI<:ho oontroo:t or agtWMftl;
ftI '~demogl'lD:
III Propony ......, used or ......i04
by. or lo....d or ran1Ill to. '"'"
parJOIlDllI1lInl1lllon;
lbl I'roprll\l /NIt whiclr m DtfIOII Dl
0IQIIIllI1I1II1 II for Ill\' 1lU1JlCI'
Il:lIIltisilv phy.iolloo""oI: or
101 'Yell, m' pemrm.d Iar !Ill
InoUlld; or
Howorot, oudI PI'''" II' orvonlzatl<<ll. not
an insurId wi1h I8IP8t1 to IIl'f.
tII 'IIodiIy injul'(, 'pnrpony demllle".
""'11n~ Dl '.lMdIrjng injllY'
lhlt_noIl1ti"'lIlo~
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(41 'IIodi1y irjwy', "ptoporty dlmag.",
"JlotIoMIlnJury' Dr "odvaRl.lng iniur(
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II IUI'/lYOl'I rondoring at, or lDih"l to
lI/Idll, IlI'/ 'PIOIwlwIIll'liol', ....
.ltCh ...... IX GlV'IIIlIt'ClIl II IIA
an:hlllCt,englnnr.'_.
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IN_
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_ or aglMlllont. l!Ial \HI
inIIlrallCl mllllbe prlmarv In. IIIIll non"
ODlIlIlblitllrv with. .uch "oth"
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COPldIhI"'___n.1lIDI
"U1ulalllld.!D1m 'ftnlun"
You are an ill$llJtt! for your plrticipalion in any
plst or present 'UIlIIIIIll.d jcint vanllll1l',
H_. you Ira nol,", inIutod If tho 'lI1ll11111d
joint .....",' lIu:
.. Oirrci ItIlplO\'ll'1; I(
II. lMN,"""', III .... I.V "'I or p......,
PfDII'tlY.
No DIlII' memlIer or plrlMI', or lI18lr 1plIUdt, Of
Iny pill or lRIlI1I'unnamlll)elm VIIWIII" IIln
In..rld,
4, The IollowinU repllUl SlCTlDN IlL LlMITI OF
LIAIILlTY.2. II.:
II. Wllllpplyllpll1llllly1o 1ho IlIIIatll~
III o.magu DRalA of 'lxIdlly lnjulY' end
'property damout'. undar sama. L
COVERAlL A. U._1lIaVI: and
(21 Modi..1 IlI'/IlIIIIlI for 'badliV 1nP'(.
~. IlI:t'lCIlI L CIWIWIE. ..
M..iell..,...... above;
.rillng '"" at _ IIICIliorI UoIoll in tho
Sc:IIeduJ. of Premia.. or NOh 01 'lour
projecta"; and
!i. The lollow'llg 11PI'cu SB:1lllM lV, CDHDmDIII.
.. "lldlIr ..._...,.. Prl..ry I_III:
121 H_, 1111. Insu....ca will be
CONidnl prillllIY to. IIId non-
canlrilutory wi1ll. 'ather illSUlUICI'
iSlued dlradly 10 . pnm 01
olll.nlmllIII IIIdlld . In Iddldlll1ll
m.wfllll undor ....0. L WHO .. AN
.lIlUm, I.:
(II PlIIQt1.M .. ~"'* A4dItItnII
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A._.._ tf
C/ilflla'lIn
Insurance', 'TlI1.1MUllnCl wlllll1en be
lOP/led " PfIIll8lV iMllrance for
dlll1lllN far 'bOOJly injury', 'ptOpIlrty
damI!It', 'pellllllal inJulY' Dr
'lldvarti';l1(j In)1II'( III WIllcl1 lhll
Inl1lranc:e eJllllJlllnd 1I1at Ira Incumd
by _ ~... qmilallan. tnd ""
wi/lllGl .holl ""'II dalllOQll' widI .d
'aIhtt Inourll1Cl'.
e. The fuUawing i. added to lil:lIDll IV.
COllllmDNI, .. "1I\Hr ,....JIG.., .. I!ac_
......01'
This Inlllrance Is _ Mr II'If 'DtIIIt
1IIIUIIIlOI' wI18lhor primary. 'XCIII,
IXlIllinIIlIt or 1fI lW1Y Diller bule 11111 II
Mlllbtl In you for your pIIti~llIlion in any
pul or pralll! '_Ill joint vonl1ll'.
7, Thl Iollowing it addId III IEC'IICIN IV.
CDllDITlllM" L TmaIIr DI Ii..... If IIItaVIry
AM 'IDneWAplIIII 0lH1I To 111:
H_, WI wolve Iny rigf!t of flClI'/8IY and
lJIQCIIds we may hili 1Ill.1n8l any perlOll or
OI\1111iatillllllatlndllldu8II\ IdditionIlI11tullld
IIIdll' Iha PlragrepI1 ...... Dr DlpIIluIIoI
1IIqtf,. ., Wrfllp ComrICt at $RfIIIM ..
WIllI. M.IIIUMD. z.:
.. BIICIUII of plIvmenlt we mok. for 'boditt
iljuy', 'prop.", damlll', 'plrtonal injur(
Dr 'adYlrti.inl liliIIV' arising 0Ill of 'your
woR' iI qoklg opanlionl or Ind_ In
tho "JllDduc:lHQrnpInld DplllIl!DIII hlzard~
Ind
.. Perfonned under . written mnlJlCl Dr
agrIIft\II\tlllat is made baflRI, enclla I~
wilen, Iha 'boditt inlWV" or 'lfDpIR'(
d8megI' oa:ur. or lhe oIt_ "'1 .......
tho 'paraonallnjlll'( or '8dvlrlI.lng irtiUl'f' II
conrnItIod; and
to Vou spedfiQlly 'grIlI in such wrltqn
C<<IlnII;I or IlII1""'nt III welVl1llDII righll
ol IICDVIC'f and proc:eecl' for IIldI pallgn or
DII1wllli...
8. TIll fIlllcoMng III Iddad 111 _CTlDN V.
DUII'I11ClIII:
........
\.~"I)RO\!E~j ,L\,'-; TO ::,OR1\'1
.____~JI5
~,,,:LL.J :,1 ~l! :::,...,:;cd/
,~lSt~:;'H City /\l1nr:I'~Y
'\.\1nnedj,int_' _JllIIIl' jolnt_..
in wfIidll'llU III I mGmbarOl JIIllnIr wIIa...,
L EacIllnd IIWI'f ... ot l'IlUr cfloVll1lu,u In
lItll /DInl _ i. 1/1 "dlilIc1tuaL
Irclnnrtlg 1If IIJII'I\1I1g tlrm; and
II. Tl1Itjaln1V111l1lrt IlIlOl nallllllln lI1a UabllIl'/
Cllvorago Part o.clltltlone.
~Yaur pmniau. mlln. Iny prtmb... lite, lI'
10CIlI1Il _od II ~iad by. or ..nlld 10, you,
'VourproJeC\':
L Maan. IIIl' prom_, .ita Or t...ti"" 01, ....
or in wfIIch "lau. work' I. not V8l~:
IIll!
... Oou nllt lnellldl _ 1lrII'IIIIa' /lI' 11I1'/
IocIlIcn IIIIllIl In lha 8dI~. dI Prernila..
AII,lhar IIIlTIIi 1II your pollC'f _In 1111 11II1I.
_.lIOn.
---..---"'...-
OwfIlr.__ctIIot....lIIIl
,."...,
, ,",; AS TO FORM
#fS,5(~--
<,:i: ell;.: I~'t;'l~;r~;ey
~
~ducabon 1st
CITY OF SANTA ANA
Public Works Agency
Traffic Engineering
P.O. Box 1988, M-43
Santa Ana, California 92702
FAX TRANSMITTAL
TO:
RE: FPL and AssociateB, Inc,
DATE:
October 28, 2005
COMPANY:
Wood-Gutmann Insurance
Brokers
FAX NUMBER:
PHONE NUMBER:
ATTACHED PAGES:
714-573-1772
714-505-7000
FROM:
Michael Ortiz
PHONE NUMBER:
714-647-5624
SUBJECT:
Certificate of Insurance
FAX NUMBER:
714-647-5616
REMARKS: Please submit the certificate of insurance with the wording crossed out on the lower right hand
side, Also, please submit the additional Insured endorsement form. Let me know if you have any
questions. Thanks!
SENDER'S NAME
Michael Ortiz
~
~ducat1on 1st
CITY OF SANTA ANA
Public Works Agency
Traffic Engineering
P.O. Box 1988, M-43
Santa Ana, California 92702
FAX TRANSMITTAL
TO: RE: City of Santa Ana Contract
DATE: October 28, 2005
COMPANY: FPL and Associates, Inc.
FAX NUMBER: 949-252-0088
PHONE NUMBER:
ATTACHED PAGES:
FROM: Michael Ortiz
PHONE NUMBER: 714-647-5624
SUBJECT: Certificate of Insurance
FAX NUMBER: 714-647-5616
REMARKS: Please submit the certificate of Insurance with the wording crossed out on the lower right hand
side. Also, please submit the additional Insured endorsement form. Let me know If you have any
questions. Thanks!
SENDER'S NAME
Michael Ortiz