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Last modified
2/2/2023 1:11:49 PM
Creation date
6/22/2018 10:18:44 AM
Metadata
Fields
Template:
Contracts
Company Name
HB STAFFING
Contract #
A-2018-147
Agency
PERSONNEL SERVICES
Council Approval Date
6/5/2018
Expiration Date
6/30/2021
Destruction Year
2026
Notes
For Insurance Exp. Date see Notice of Compliance
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coW CERTIFICATE OF LIABILITY INSURANCE <br />;0;6/27/ oll8 " <br />aZBTYG$ <br />INSR <br />LTR <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(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 />CONTACT <br />NAME: Mia COm aratto <br />World Wide Specialty Programs, Inc. <br />PHONE FAX <br />AIC IN Ex", (631)390-0800x120 me No: 631-390-0922 <br />68 South Service Road, Suite 235 <br />WOO mcomparetta�wwspl.com <br />Melville, NY 11747 <br />PRODUCER <br />6223 <br />INSUREIR(Sl AFFORDING COVERAGE NAIC9 <br />X COMMERCIAL GENERAL LIABILITY <br />INSURED <br />INSURERA: Zurich American Insurance Company Qf lUjIlo <br />Cathy3on Enterprises, Inc. dba HB Staffing <br />INSURER B: Zurich American Insurance Company 16535 <br />2120 Main Street <br />INSURER C: American Guarantee & Liability Insurance Co 26287 <br />Suite 250 <br />WSURERD: <br />Huntington Beach, CA 92648 <br />INSURERS: <br />INSURERF: <br />05/01/18 <br />COVERAGES CERTIFICATE NUMBER: RFVISION NHMRFR• <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 />SUB <br />POUCYNUMBER <br />POUCYEFF <br />IM=DffYYYI <br />POLICY EXP <br />IMMIDDrYYYY)LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ ] 000 () <br />X COMMERCIAL GENERAL LIABILITY <br />DAMAGE <br />PREMISES ce $ 100000 <br />MED EXP Arry one person) $ 10,000 <br />B <br />CLAIMS -MADE OCCUR <br />PRA 5908492-05 <br />05/01/18 <br />05/01/19 <br />PERSONAL& ADV INJURY $ 11000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GEN'L AGGREGATE LIMIT "PLIES PER: <br />PRODUCTS -COMPMP AGO $ 2,000,000 <br />X1 POLICY PRO- LOC <br />S <br />AUTOMOBILE <br />LUMUTY <br />ANY AUTO <br />COMBINEDSINGLELIMIT (Ea accident)) $ 1,000,000 <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) $ <br />B <br />X <br />SCHEDULEDAUTOS <br />HIREDAUTOS <br />PRA 5908492-05 <br />05/01/18 <br />05/01/19 <br />PROPERTY DAMAGE $ <br />(Par accident) <br />X <br />NON-OWNEDAUTOS <br />$ <br />S <br />X <br />UMLA LUIS <br />X <br />OCCUR <br />EACH OCCURRENCE $ 1,000,000 <br />C <br />UCESS UAB <br />CLAIMS -MADE <br />UMB 5499499-05 <br />05/01/18 <br />05/01/19 <br />AGGREGATE $ 1,000,000 <br />DEDUCTIBLE <br />$ <br />X <br />RETENTION $0.00 <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRETOR.PARTNEJUEXECUTIVE <br />OFFICERRrEMBER EXCLUDED? <br />NIA <br />WC5714560-00 <br />04/09/18 <br />04/09/19 <br />X We STATU-OTH- <br />1 TORY LIMITS <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L.DISEASE-EAEMPLOYE $ 1,000,000 <br />(Mandatoryln NH) <br />0yeadescebeCRIPTION under OPERATIONS below <br />DES <br />E.L. DISEASE -POLICY LINT $ 1.000.000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Mach ACORD 101, ACdrdonal Remarks SeheduI% N more space Ia requ[,Wl <br />Blanket Waiver of Subrogation and BlanketAlternative Employer Endst. is included on the WC policy.The City of Santa Ana,its <br />ofHcers,employees,agents and representatives are named as additional insured as respects to the General Liability policy. <br />CERTIFICATE HOLDER CANCELLATION <br />16223 SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana Public Works ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Piz <br />Santa Ana, CA 92701-4058 AUTHOR4RBPRBSEWATNE �•--� Z Dorothy Taylor <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of <br />
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