Laserfiche WebLink
DATE (MM/DD/YYYY) <br />CERTIFICATE OF LIABILITY INSURANCE <br />08/20/2020 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE <br />AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE <br />ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, <br />subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does <br />not confer rights to the certificate holder in lieu of such endomement(s). <br />PRODUCER <br />CONTACT NAME: <br />PAYCHEX INSURANCE AGENCY INC/PHS <br />PHONE (800)472-0072 <br />(A/C, No, EA): <br />FAX (585)389-7894 <br />76210756 <br />150 SAWGRASS DRIVE <br />E-MAIL ADDRESS: <br />ROCHESTER NY 14620 <br />INSURERS) AFFORDING COVERAGE NAIC# <br />INSURERA: Hartford Fire and Its P&C Affiliates <br />00914 <br />INSURED <br />INSURER B: <br />HADRONEX INC DBA SMART COVER SYSTEMS <br />INSURER C: <br />2110 ENTERPRISE ST <br />INSURER D: <br />ESCONDIDO CA 92029-2000 <br />INSURER E: <br />INSURER F: <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.NOTWITHSTAN 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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSIR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY UP <br />LIMITS <br />I <br />INSR <br />MD <br />MM/DD/YYYY <br />MM/DD/Y YYV <br />COMMERCIAL GENERAL ABILITY <br />EACH OCCURRENCE <br />CI -AIMS -MADE OCCUR <br />DAMAGE TO RENTED <br />PREMISES Ea occurrence <br />MED EXP (Any one person) <br />PERSONAL &ADV INJURY <br />GENU AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />POLICY PRO- JECT LOD <br />PRODUCTS - COMP/OPAGG <br />OTHER'. <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident) <br />BODILY INJURY (Per person) <br />ANY AUTO <br />ALL OWNEDF7 SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />HIRED NON-OVNJED <br />AUTOS AUTOS <br />(Per accident) <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAB <br />CLAIMS - <br />MADE <br />AGGREGATE <br />DED <br />RETENTION$ <br />WORKERS COMPENSATION <br />X <br />PER <br />OTH- <br />AND EMPLOYERS' LIABILITY <br />STATUTE <br />ER <br />E.L EACH ACCIDENT <br />$1,000,000 <br />ANY YIN <br />A <br />PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBEREXCLUDED? <br />N/A <br />76 WEG GH3220 <br />10/01/2019 <br />10/01/2020 <br />E.L. DISEASE-EAEMPLOVEE <br />$1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />E. L. DISEASE -POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, AeId'Rional Remarks Schedule, may be aCached If more space is required) <br />Those usual to the Insured's Operations. Notice of Cancellation will be provided in accordance with Form WC990394, attached to this policy. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br />Risk Management Division <br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br />20 CIVIC CENTER PLZ FL 4 <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />SANTA ANA CA 92701A058 <br />�-IF4100I <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />Rime Mallaganent Division <br />REVIEWED & APPROVED BY: <br />faaa.o:.r.e Z V @Qbnebd <br />'� Risk Management Analyst <br />