PALEOWEST, LLC - Laserfiche WebLink

Home Browse Search

Digitall signed by ,4 CERTIFICATE OF LIABILITY WSt VIR An ieD� 1i9�'� 2 /2o z THIS Q ��,,{5 CERTIFICATE CDOES NOT AFFIRMATIVELY EOR NEGATIVELY AMEND, EXTEND0 1T I 1 N$D �r `}�Rk17LfOR(l,� BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTR C REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 RBN &Associates, Inc. 303 E Wacker Dr Suite 650 Chicago lL60601 CONTNAMEACT S mOne White PHONED B 312-856-9400 FA1c ac Nq:312-Sss-9425 nooaEss: swhite@rbninsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: Hartford Fire Insurance Co. 19682 INSURED PALELLG01 PaleoWesR, LLC 319 E Palm Lane Phoenix AZ 85004 INSURERS: Trumbull Insurance Company 27120 INSURER C: Hartford Casualty Insurance Cc 29424 INSURER D : Hartford Underwriters Ins. Co. 30104 INSURERE: Indian Harbor Insurance Co. 36940 INSURER F: 49 R I I a LMa\I MO 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 ABBL SUBR wynPOLICY NUMBER MMDDg1EYYY MM%UOYYIYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 83UENAE3802 12/30/2021 12/39=22 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO ENTED PREMISES se accumma $300.000 MED EXP(Any one person) $10,000 PERSONAL &ADV INJURY $1.000,D00 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,OOU GEN'L POLICY�PRO- ❑ LOG ECT PRODUCTS-COMP/OP AGG $2,000,000 $ OTHER' B AUTOMOa1LELIABILITY Y V 83UENAF0512 12/30/2021 12/3012022 COMBINED SINGLE LIMIT Ea accident $.1,OOQ000 X N BODILY INJURY (Per person) $ O OWNED, BODILY INJURY (Per accitlent) $ AUTOS ONLY AUTOSSCHEDULED X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPEPERTY DAMAGE Per accident) $ $ C X UMBRELLA LIAB X OCCUR 83RHUAE4701 12/30/2021 12/3012022 EACH OCCURRENCE $5,00Qo00 EXCESS LIAR CLAIMS -MADE AGGREGATE $5,000,000 DED I x I RETENTIONS p WORKERSCOMPENSATION ANDMPLOYERS'LIABILITY V 83VEAMIAZL 12/30/2021 12/30/3022 X PER OTH- YIN STATUTE ER E.L. EACH ACCIDENT $1000000 ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? NIA E. L. DISEASE - EA EMPLOYEE 51.000,000 (Mandatory in NH) Ifyes, describe under EL.DISEASE - POLICY LIMIT S1,D00,000 DESCRIPTION OF OPERATIONS below E Professional E&O MPP 9044566 12/30/2021 12/30/2022 Per Claim/Aggregate 5,000,000 Deductible 25.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) City of Santa Ana, officers, agents, employees, and volunteers. Additional Insured on a primary non-contributory basis with respect to. General Liability and Auto Liability as required by written contract. A Waiver of subrogation applies in favor of the Additional Insured with respect to General Liability, Auto Liability, and Workers Compensation as required by written contract. 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 AUTHDRIZED REPRESENTATIVE Santa Ana CA 92702 ��- Riale MarlPgenlmt Divieipn y��g�i�" %�� REYIEV/ED&APPROVED BY. ©1988-2015 ACORD 541111111i'rL3 >�� Aetv4ie ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD �'' Risk ManagemeRr spedalisr