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HENNESSEY & HENNESSEY LLC (3)
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HENNESSEY & HENNESSEY LLC (3)
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Last modified
12/16/2021 5:25:17 PM
Creation date
12/16/2021 5:24:27 PM
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Contracts
Company Name
HENNESSEY & HENNESSEY LLC
Contract #
A-2018-293-01
Agency
Public Works
Council Approval Date
12/18/2018
Expiration Date
12/17/2022
Insurance Exp Date
5/15/2022
Destruction Year
2027
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Digitally slyned by Francine R. <br />Francine R. Villareal Villareal <br />CERTIFICATE OF LIABILITY INSURANCE <br />DA06/08/aD(YYYrj <br />06l08/2021 <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 poitcy(les) must have ADDITIONAL INSURED provlslons 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 andomement s . <br />PRODUCER <br />$tateArM TERRY BRADSHAW, AGENT LIC. 1WB80831 <br />NaACT KAREN VASQUEZ <br />PHONE Eel 714-637-4120 F X 8s: 714-637.4260 <br />17871 SANTIAGO BLVD., SUITE 207 <br />ro VILLA PARK, CA 92861 <br />MAIL KARENQ7ERRYBRADSHAW.ORG <br />R 38: <br />INSURERS AFFORDING COVERAGE <br />NAIC if <br />INSURER A: State Farm General Insurance Company <br />25151 <br />INSURED <br />INSURER 0 : State Farm Mutual Automobile Insurance Company <br />25178 <br />HENNESSEY & HENNESSEY, LLC. <br />INSURER C: <br />1760217TH STREET, SUITE 102-246 <br />_ <br />INSURER D: <br />TUSTIN. CA 92780 <br />IN UREA F •; <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDINO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />TYPE CF IHBURANCE <br />PL <br />SUSR <br />POLICY UMBER <br />POLICY <br />PMUC EXPLIMITS <br />rNS <br />COMMERCIAL. GENERAL LIAaILfY <br />CLAIM&MADE �OCCUR <br />Y <br />Y <br />92-CZ-W382-6 <br />05/16/2021 <br />05116/2022 <br />EACH OCCURRENCE <br />$ 1,000,000 <br />co <br />300,000PREMISES <br />$MEDEXP(Aayoneperren) $ 5,000 <br />PERSONALSADVINJURY <br />$ 1,000.000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />X POLICY ❑ jECi LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS -COMPIOP AGO <br />$ 2,000,D00 <br />$ <br />B <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLYAUTOS <br />HIRED �/ NON -OWNED <br />AUTOSONLY /� AUTOS ONLY <br />Y <br />Y <br />471 7092-E19-75G <br />0511912021 <br />l l/19/2022 <br />COMBINED SINGLE LIMITa <br />1.000,000 <br />BODILY INJURY (Par person) <br />S -. <br />BODILYINJURY(PmacoBvmj <br />$ <br />PROPERTY OAMA <br />Pore a <br />" <br />A <br />X <br />UMBRELLALIAB <br />EXCESSLIAd <br />X <br />OCCUR <br />CLAIMS -MADE <br />N <br />N <br />92-CZ-W386.5 <br />06/16/2021 <br />05/15/2D22 <br />EACH OCCURRENCE <br />,000,000 <br />!$j2' <br />AGGREGATE <br />000,000 <br />DEO <br />I I RE TION <br />_ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIARILRY YIN <br />OFFICE OPRIETERAPARTNERIEEXCLU ECUTIVE O <br />(Mendaforyln NN{ <br />If SCdescdb0Rnder <br />DESCRIPTION OF OPERATIONS edma <br />NIA <br />PE TfITE OR <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE •EA EMPLOY <br />$ <br />E.L- DISEASE -POLICY LIMIT <br />$ ' <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tACORD 101, Addlllonal Remarks Samdula, maybe Mlaehed if more apace Is faqulmd) <br />City of Santa Ana, officers, agents, employees, and volunteers are named as additionally Insured on this policy pursuant to written contract, agreement, or <br />memorandum of understanding. Such Insurance as Is afforded by this policy shall be primary, and any insurance carded by City shall be excess and <br />noncontributory <br />Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE )AiEREOP, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE_POtJCy PROVISIONA 0 / <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION AUTHORIZEDREPRESENTATIIIE <br />20 CIVIC CENTER PLAZA Completed by an aUthor• ed State <br />SANTA ANA, CA 92702 Is required, please contact a State <br />©1988.2015 ACORD i <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />f R, k" <br />Risk Marlagmnlent Analyst <br />
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