|
JLEEENG-01
<br />YUENG
<br />a►coRO` CERTIFICATE OF LIABILITY INSURANCE
<br />llli/
<br />DATE(MMIDD/YYYY)
<br />1 312/2020
<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 endorsements .
<br />PRODUCER License # OE67768
<br />IOA Insurance Services
<br />3875 Hopyard Road
<br />Suite 209
<br />Pleasanton, CA 94588
<br />CONTA
<br />NAME:CT Gig! Yuen
<br />PHONE FA%
<br />lac, No, Ext: (925) 660-3514 50008 uc, Nq:(925) 416-7869
<br />Ao A'L,ss. Gigi.Yuen@ioausa.com
<br />INSURERS AFFORDING COVERAGE
<br />NAICM
<br />INSURER A: Travelers Property Casualty Company of America
<br />25674
<br />INSURED
<br />INSURERB:Arch Insurance Company
<br />11150
<br />INSURER C :
<br />JLee Engineering, Inc.
<br />INSURER D:
<br />430 S. Garfield Avenue, #301
<br />Alhambra, CA 91801
<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. 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 />TYPE OF INSURANCE
<br />ADDLSUBR
<br />INSD
<br />WVD
<br />POLICYNUMBEft
<br />POLICY EFF
<br />IMMMDffYYYI
<br />POUCYEXP
<br />(MMIDD[YYYY1LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />CLAIMS -MADE �X OCCUR
<br />6802HO13864
<br />911/2019
<br />911/2020
<br />DAMAGE TO RENTED
<br />PREMISES Ea Occurrence)
<br />$ 1,000,000
<br />MED EXP An ona arson
<br />$ 10,000
<br />PERSONALSADV INJURY
<br />5 2,000,000
<br />GEML
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY JELQT LOC
<br />GENERAL AGGREGATE
<br />4,000,000
<br />PRODUCTS -COMP/OPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />2,000,000
<br />BODILY INJURY PerPerson)
<br />$
<br />AUTO
<br />6802HO13864
<br />9/112019
<br />9/112020
<br />BODILY INJURY Per accident
<br />OWNED SCHEDULED
<br />IxANY
<br />AUTOS ONLY AUTOS
<br />PeOPERident AMAGE
<br />$
<br />HIRE X NON S NED
<br />AUT�S ONLY AUTOS ONLY
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />Cl-AIMS-MADE
<br />DED RETENTION $
<br />A
<br />WORKERS COMPENSATION
<br />LIABILITY
<br />AND EMPLOYERS' ABILITY YIN
<br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑
<br />qq�antlaroryEM NH EXCLUDED?
<br />(M )
<br />NIA
<br />UB3J84391A
<br />9/1/2019
<br />911/2020
<br />PER OTH -
<br />X I STAT ER
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$
<br />E.L DISEASE - EA EMPLOYE
<br />1,000,000
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />1,000,000
<br />If yes describeunder
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab.
<br />PAAEP00102501
<br />9/112019
<br />91112020
<br />Per Claim
<br />1,000,000
<br />g
<br />Professional Liab.
<br />PAAEP00102501
<br />911/2019
<br />9/1/2020
<br />Aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Effective 212812020, Professional Liability limit increased to $1,000,000 per claim & $2,000,000 aggregate.
<br />All Operations of the Named Insured.
<br />General Liability: See Additional Insured Endorsement attached; such Coverage is Primary & Non -Contributory and includes Separation of Insureds, as
<br />required per written contract.
<br />NOTE: No company -owned vehicle. General Liablity includes coverage for Hired 8 Non -Owned Auto Liability.
<br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Santa Ana, its Officers, employees, and
<br />SEE ATTACHED ACORD 101
<br />RgE LIMEy Risk D MEn DIVISION
<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 />City of Santa Ana MA O
<br />20 Civic
<br />AUTHORIZED REPRESENTATIVE
<br />At CiPlanning Department
<br />vic Center Plaza
<br />Lcanra Ana CA O77n9
<br />ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
|