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Last modified
5/17/2024 11:06:39 AM
Creation date
5/17/2024 10:43:04 AM
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Contracts
Company Name
JOE MACPHERSON FORD
Contract #
A-2024-029-02
Agency
Public Works
Council Approval Date
2/20/2024
Expiration Date
2/20/2027
Insurance Exp Date
1/1/2025
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1 as <br />"`✓ o CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMODIYYYY) <br />04/04/2024 <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(les) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />ADD Risk services South, Inc.PHONE <br />Atlanta GA Office <br />CONTACT <br />NAME: <br />(866) 283-II22 FAR (800) 363-0105 <br />(AC. No. Esg: AN;. No.: <br />3550 LenoX Road NE <br />Suite 1700 <br />E-MAIL <br />ADDRESS: <br />Atlanta GA 30326 USA <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURED <br />INSURERA: Safety National Casualty Corp <br />15105 <br />AutONati On, Inc. <br />200 SW 1st Avenue <br />INSURER B: <br />INSURER C: <br />Suite 1400 <br />Ft Lauderdale FL 33301 USA <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 5/U1U4987966 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. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />MO <br />POLICY NUMBER <br />MMIOD/Yy <br />MM�O <br />LIMITS <br />CO MMERCIALGENERALLMBUITY <br />EACHOCCURRENCE <br />CLAIMS -MADE ❑ OCCUR <br />PREMISES Ea occuaenra <br />MED EXP (Any one person) <br />PERSONAL a ADV INJURY <br />GEML AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />POLICY ❑ PRO ❑ LOC <br />JECT <br />PRODUCTS -COMP/OPAGG <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea acdd.. <br />BODILY INJURY ( Par parson) <br />ANYAUT , <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED AUTos NON -OWNED <br />ONLY AUTOS ONLY <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />Paraaident <br />UMBRELLALIAS <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESS LIAR <br />I CLAIMS -MADE <br />DEO I RETENTION <br />A <br />A <br />WORKERS COMPENSATION AND <br />EMPLOYERTLIABILITY Y/N <br />ANY PROPRIETOR I PARINER1 OFFICENMEMBER EXCLUDED?EXECUTIVE <br />(Mandatory In NM <br />NIA <br />LD54068558 <br />ADS <br />P54068557 <br />WI <br />01 01 2 22401 <br />01/01/2024 <br />01 2025 <br />01/01/2025 <br />X PER STATUTE I OTH- <br />ER <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />EL DISEASE -EA EMPLOYEE <br />$1,000,000 <br />N yas,describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L DISEASE -POLICY LIMIT <br />$1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 11 more apace is required) <br />AutONati On Ford Tustin is included as a Named Insured. <br />d <br />CERTIFICATE HOLDER CANCELLATION aK <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />city of Santa Ana <br />Risk Management Division <br />20 civic Center Plaza <br />Santa Ana CA 92702 USA <br />©1988-2015 ACORD CC <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />liiek MAmgemmt➢IVL91On s-) <br />REVIEWED dr APPRWED ✓31' -� <br />Risk Management Specialist <br />Y <br />
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