Laserfiche WebLink
MMC 10/16/2008 10:57:02 AM PAGE 3/006 Eastern Time Zone <br />_ _ _ DATE(MM/DD/YYYY) <br />A RD CERTIFICATE OF LIABILITY INSURANCE 10/15/2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />. Inc. NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />M4400arsh UCommi SA. Bank Tower HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />1717 Main St <br />Dallas, TX 75201-7357 <br />Attn. dallas.ceds?marsh.com Fax. 212-948-0519 OVERAGE NAIC At <br />063185-AII-08-09 LA D623B 5M INSURERS AFFORDING C <br />((?1 ^^ rance Company of The State OI PA 16428 <br />INSURED yl ?t..(i0- - U, <br />Royal Street Communications, LLC U 1 INSURER R A B INnsuational Union Fire Ins Co Pithburgh PA 19445 <br />2435 NI Central Expressway, 81200 INSUREB <br />Richardson, TX 75080 A-007-0`43 INSURER; <br />NSURER D <br />A ?7-o tfy <br />INY!'FEB E <br />COVERAGES _ <br />THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI00 INDIG0.TED RESP <br />TO W <br />ICH NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION Of ANY CONTRACT OR <br />Fc n SCn IBIFORHEREIN IS WITHUBJECT TO AC L THE EIRMSETHIS XCLUSIONS AND <br />A. T?l MAY BE ISSULU UH MAI r <br /> REG ATE LIMITS SHOWN MAY HAVE BEEN R EDUCED BY PAID CLAIMS _ <br /> CONDITIONS OF SUCH POUCIES AGG P OLICY EfFECTIYE P OLICY EXPIRATION LIMITS <br />ryg ADDt? <br />TYPE OF INSURANCE POLICY NUMBER DATE IMMIDWYVj DATE IMMIDDNY) <br />LTHI NSR r, 1 000 DO <br /> % GL1871946 09101/08 1 09/01/09 DAMAO'E TREI $ 1,000.00 <br />A BI <br />ITY -REMISES E9 ]SWerl<er <br /> L <br />X C?IMMER]I A_ D ENERA. ,A nl 00 <br />10 <br /> NEC EXP(MVCnn Pe%> , <br />$ <br /> ?pr„I,a <br />CLAIMS MAUE I 000 <br />00 <br /> _ <br />X PERWNALBADVIN $ 1, <br />, <br /> ? General AggregateLuTa1- <br />GE VEaAL AGGREGATE <br />$ 2000,00 <br /> Pe Po licv 510000000 <br /> _y <br />GENERAL AaGREGATE LIMIT APPJES PER FROCIICTS :LiIVIIiPAG 2,000,00 <br /> PRC <br />POLL:V X ",'I X <br /> AUTOMOBILE LIABILITY AL16O 793 . 091 09/01/09 i COMBINED SIN3,E LIMIT $ 1,000,00 <br />A X Ea ox dn,V <br /> ANY AI IiU <br /> X <br />INJURY <br />BOJI <br /> <br />$ <br /> ALL CWNEC AYOS it <br />I lFn _ <br />SCHECULED Al Cr,S <br />X I HIRECAJTJS s.CI V INJURY $ <br /> Aw xrrp9m) <br />X NO&OWNES AI-TVs <br />DAMAGE <br />Comp $1.000 Ded <br />X PPe?e Eadem $ <br />% Coll 1 000 Ded <br />GARAGE BABLLITV AUTO ONLY - EA ACCIDENT $ <br /> EA M <br />i,THER THAN C <br />'$ <br />ANYX TO 1AUTOONLV $ <br /> A3G <br />EXCESSUMBRELAA UAeIUTY BE6081872 09/01/08 09101/09 EACH xCLRRENCE $ 5,000.00 <br />B K ? <br />MADE <br />CLAIM AGGRECATE $ 5,000,00 <br />. <br />.DOUR $ <br /> DE-:IT-TICLC $ <br /> X FF'FxTI IN £ <br />A WORKERS COMPENSATION AND WC4800627 (ADS) 09/01/08 091 X AO STATLL orH <br />EMPLOrERS UAe&rtv WC4800628(CA) 09101108 09101!09 EL EACH ACCIDENT $ 1,000,00 <br />'A' ANV'PRaPR E7CR/=ARTNERrXF4I IT VE <br />EL DISEASE FA EMFU?YE $ 1,000,000 <br />OFFI-EPJVEMER EXJLJCCLI'+ <br />S IM UF Oe I; In <br />BbEGIA_ RG L- ID Ns L. DISEMSE POLICY LIMB $ 1,000.00 <br /> OTHER <br />DESCRIPTION OF OPERATION &LOCATIONSNE111C LESEXCLU SIGNS ADOED BY ENDORSEMENTMPECIAL PROVISIONS <br />Re: Site 41LAO823B/Madison Park 1528 S Standard Ave., Santa Ana, CA 92707 <br />t on Workers' Comp) as respects operations of the Named Insured. <br />Additional Insured (exce <br />i <br />H <br />ld <br />C <br />tifi <br />p <br />er <br />s an <br />er <br />cate <br />o <br />Where required by written Contract, <br />Hal der <br />t <br />fi <br />t <br />f th <br />C <br />i <br />ca <br />e <br />e <br />er <br />Where required by written contract, the above referenced Pdrey(s) includes Waiver of Subrogation in favor o <br /> <br />CERTIFICATE HOLDER HOU-0 00 8 381 25-09 CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />City of Santa Ana <br />Attn. Carla Thompkins - Parks, Rec.& Community Services 30 DAYS WRITTEN NOTICE70 THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />I BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND <br />ecu <br />Executive Director <br />888 W Santa Ana UPON THE INSURER. ITg AGENTS DR REPRESENTATIVES. <br />Santa Ana, CA 92702 p <br />Ar <br />?¢E <br />p <br />YPF9FMTATVE <br />YITNH <br />A MerENU Inc <br /> i <br />a <br />m <br />H <br />in <br />William Hines <br />- - _^^nn wnen ne Arrnu ?eAs <br />ACORD 25(2001/08) !1\ L y„ FL,r?) <br />PIP <br />Fax from L` 5{ ?!(9u/ /G/<??C'0 <br />10/16/08 87:57 Pg: 3