|
�,,^1 STRACOM-01 LEUJAI
<br /> ,%C R1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
<br /> 1/17/2024
<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(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 endorsement(s).
<br /> I-PRODUCERCONTACT
<br /> NAME;_ __
<br /> Auto Club Services,LLC PHONE ' FAX
<br /> 2601 S.Figueroa St (Arc,No,Ext):(888)416-2402 I(NC,No):
<br /> MS H302 EMAIL
<br /> Los Angeles,CA 90007 _ADDRESS:
<br /> INSURER(S)AFFORDING COVERAGE NAIC#
<br /> INSURER A:Infinity Select 20260
<br /> INSURED INSURER B:
<br /> Stralghtline Communications,LLC INSURER C:
<br /> Linda O'Hanlon
<br /> 14930 Greenleaf St INSURER D:
<br /> Sherman Oaks,CA 91403 INSURERS:
<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 /> me I TYPE OF INSURANCE IADDL,SUBRI I POLICY EFF ' POLICY EXP ' —""
<br /> _LIB 'INSD YIVD POLICY NUMBER I IMMt00/YYYYI I IMM!DD(YYYY)1 LIMITS
<br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 _ _
<br /> CLAIMS MADE OCCURDAMAGE d S TO RENTED
<br /> w PREMISES l$ -
<br /> MED EXP(Any one person) S
<br /> PERSONAL a ADV INJURY S
<br /> GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S
<br /> POLICY EECT LOC PRODUCTS-COMP/OP AGG J
<br /> OTHER
<br /> $
<br /> A AUTOMOBILE L1ABIUTY I EaIeBINEpD�SINGLE LIMITS 1,000,000
<br /> ANY AUTO X I X ,50003423001 2/13/2024 2/13/2025 BODILY INJURY(Per person) $
<br /> OIMIEDONLY X,SCHEDULED ---
<br /> AUTOS AUUTOSSy�/ryEp BODILY INJURY(Per accdent) S _
<br /> AUTOS ONLY AUTOS ONLY (Peraccideent) AGE $
<br /> - S
<br /> _ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ _
<br /> EXCESSLU\B CLAIMS-MADE
<br /> AGGREGATE S
<br /> DED I RETENTION S S
<br /> WORKERS COMPENSATION I • PER OTH-
<br /> AND EMPLOYERS'LIABILITY `1 N STATUTE ER
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH S
<br /> O FICERIMEMBER EXCLUDED? j_J N f A —
<br /> (t andatory In NIl)
<br /> If yes,desrnbe under E L DISEASE-EA EMPLOYEE;S
<br /> DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $
<br /> i
<br /> i
<br /> DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is re qulred)
<br /> City of Santa Ana,its officers,employees,agents and representatives are Additional Insureds with respect to Commercial Auto Liability per the attached
<br /> endorsements as required by written contract Insurance Primary and Non-Contributory.Waiver of Subrogation applies, Kemper Infinity Commercial Auto will
<br /> provide 30 Days Notice of Cancellation with 10 Days Notice for Non-Payment of Premium in accordance with the policy provisions.
<br /> Schedule Auto:2019 BMW X3 Vinf SUXTR7C54KLR51417
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> City of Santa Ana THE EXPIRATION DATE THEREI�
<br /> ACCORDANCE WITH THE POLICY PF
<br /> Risk Management Division,4th Floor , ort RiskManagemelltDivis)on
<br /> 20 Civic Center Plaza /��� REVIEWED&APPRCNED BY:
<br /> Santa Ana,CA 92702 AUTHORIZED REPRESENTATIVE I� ����; ��
<br /> �_"� °;S�IiL7I_IILL A tQceva"a
<br /> U ��, Risk Management Specialist
<br /> ACORD 25(2016/03) 01988-2015 ACORD..,,,,,, S,,,,,,,,,,,,, 1,ff.„y„W 103CrVCY•\
<br /> The ACORD name and logo are registered marks of ACORD
<br />
|