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SOLOMON, STEPHEN
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SOLOMON, STEPHEN
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Last modified
4/23/2021 4:20:01 PM
Creation date
3/13/2019 8:23:01 AM
Metadata
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Template:
Contracts
Company Name
SOLOMON, STEPHEN
Contract #
N-2019-049
Agency
PLANNING & BUILDING
Expiration Date
2/12/2021
Insurance Exp Date
6/1/2021
Destruction Year
2026
Notes
WC NOT NEEDED AS VENDER HAS NO EMPLOYEES.
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CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MM/DD/YYYY) <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 have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER MAUR- T <br />COMPLETE EQUITY MARKETS INC <br />1190 Flex Court <br />Lake Zurich, IL 60047 <br />dba Complete Equity Markets Insurance Agency, Inc. <br />INSURED <br />Stephen H. Solomon <br />18861 Ridgewood Lane <br />Villa Park. CA 92861 <br />INSURER(S) AFFORDING COVERAGE <br />INSURERA: Underwriters at Llovd's Londl <br />INSURER C : <br />INSURER E : <br />f`f1\/CD A!_CC (-FfPTIl7Ir ATF NI IMRFR• RFVISIf7N 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 />IR <br />LTWVD <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />SUER <br />POLICY NUMBER <br />PO DD EFF <br />MM/D Y t:7CP <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />WhWG__E O RENTED <br />PREMISES Ea occurrence <br />$ 50 000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL BADV INJURY <br />$ EXCLUDED <br />A <br />X <br />1500249 <br />2/5/2019 <br />2/5/2020 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2.000.000 <br />PRODUCTS - COMP/OP AGG <br />$ 1,000,000 <br />X POLICY PE r LOC <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COM$INEA SINGLE LIMIT <br />Ea accdent <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Par accident <br />$ <br />$ <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DIED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY \, / N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />$ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatory in NH) <br />N / A <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />Each Claim <br />$1,000,000 <br />Professional Liability <br />X <br />X <br />857634 <br />611/2018 <br />6/1/2019 <br />re <br />Aggregate 9ate <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />See pages 2, 3 and 4 for additional information. <br />CERTIFICATE HOLDER CANCELLATION <br />The City of Santa Ana <br />Civic Center <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <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 />ACORD 25 (2016103) <br />© 1988-2015 ACORD CORPORATION <br />The ACORD name and logo are registered marks of ACORD <br />All rights reserved. <br />
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