NATIONAL SAFETY SERVICES - Laserfiche WebLink

Home Browse Search

Digitally signed by Francine R. Francine R. Villareal Villareal A� " CERTIFICATE OF LIABILITY INSURANCE rDA1E (MM /DD/YYYY) 2/1/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Wood Gutmann & Bogart Insurance Brokers 15901 Red Hill Ave., Suite 100 Tustin CA 92780 CONTACT NAME: Michael Tran PHONE FAx A/c No Ext: 714-824-8384 A/C No:714-573-1770 ADODRESS: mtran@wgbib.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: State Compensation Ins Fund 35076 License#: 0679263 INSURED NATIO14 INSURERB: CRUM & FORSTER SPECIALTY INS CO 44520 National Safety Services, Inc. 9121 Atlanta Ave Unit #732 INSURERC: NATIONWIDE MUT INS CO 23787 INSURERD: Huntington Beach CA 92646 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1387298806 REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYY POLICY EXP MM/DD/YYY LIMITS B X COMMERCIAL GENERAL LIABILITY EPK133928 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR PREMISES DAMAGE TO ccurrence PREMISES Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 Deductible $ 5,000 OTHER: C AUTOMOBILE LIABILITY ACPBA3019636948 2/1/2021 2/1/2022 COMBINED SINGLE LIMIT Ea accident $ 1 000 000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X Per a RTY DAMAGE $ HIRED AUTOS X NOTOSWNED B UMBRELLA LIAB X OCCUR EFX116916 2/1/2021 2/1/2022 EACH OCCURRENCE $ 1,000,000 X AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N 9124080 2/4/2021 2/4/2022 )( PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ Included (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Included B Professional Liability EPK133928 2/1/2021 2/1/2022 $1,000,000 Limit $5,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, its officers, employees, agents, volunteers, and representatives are named as additional insured on the General Liability per attached EN0351 0217 & EN0350 0217 as required by written contract subject to the terms and conditions of the policy. Primary and Non -Contributory applies on the General Liability per attached EN0348 0217. 30-Day Notice of Cancellation (other than non -pay) applies per attached EN0136-0211 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 �E RiskManagemerdUlMsian /.r., - 3 � REVIEWED &APPROVED SY: @ 1988-2014 ACORD C z m , ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ��y Risk Management Analyst