Laserfiche WebLink
? ?® <br />A CERTIFICATE OF LIABILITY INSURANCE DATE /YYYY) <br />08,3,/2012 120,2 <br /> <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 be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER CONTACT <br />NAME: <br />Marsh USA, Inc. _ <br />PHONE aC <br />4400 Comerica Bank Tower No (A/C. No, Extla <br />1717 Main Street E-MAIL <br />ADDRESS: <br />Dallas, TX 75201-7357 <br />com Fax: 212-948-0519 <br />Attn: dallas <br />certs@marsh INSURER(S) AFFORDING COVERAGE NAIC # <br />. <br />. <br />063165-CAS-GAWU-12-13 LA 0623B 5M Y No INSURER A : Insurance Company Of The State Of PA 19429 <br />INSURED INSURER B : National Union Fire Insurance Co. of PA 19445 <br />MetroPCS Communications, Inc <br />. <br />New Hampshire Insurance Company <br />23841 <br />2250 Lakeside Boulevard INSURER C : <br />Richardson, TX 75082 INSURER D : Illinois National Insurance Company 23817 <br /> INSURER E : Commerce And Industry Ins Co <br />[ 19410 <br /> INSURER F : National Union Fire Insurance Co 19445 <br />COVERAGES CERTIFICATE NUMBER: HOU-002066468-45 REVISION NUMBER:4 <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 />INSR ADD[ SUBR POLICY EFF POLICY EXP <br />LTR <br />TR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS <br />A GENERAL LIABILITY GL7146386 09101/2012 09/01/2013 EACH OCCURRENCE $ 1'000'000 <br /> X DAMAGE TO RENTED 1 <br />000 <br />000 <br /> COMMERCIAL GENERAL LIABILITY PREMISES Ea occurcence , <br />, <br />$ <br /> CLAIMS-MADE M OCCUR MED EXP (Any one person) $ 10,000 <br /> X Limited Pollution Liab/General PERSONAL & ADV INJURY $ 1'000'000 <br /> X Agg. Limit Per Policy $10MM GENERAL AGGREGATE $ 2,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ 2,000,000 <br /> X POLICY LE PRO- X LOC <br />JECT $ <br />A AUTOMOBILE LIABILITY CA3447212 (ADS) 09/01/2012 09/0112013 COMBINED SINGLE LIMIT 1 <br />000 <br />000 <br /> Ea accident , <br />1 <br />E X ANY AUTO CA3447213 (MA) 09101/2012 001/2013 BODILY INJURY (Per person) $ <br /> ALL OWNED <br />AUTOS SCHEDULED <br />AUTOS BODILY INJURY (Per accident) $ <br /> <br />X <br />X <br />NON- <br />OWNED PROPERTY DAMAGE <br />$ <br /> HIRED AUTOS AUTOS Per accident <br /> Comp/Coll Deductible $ 1,000 <br />B X UMBRELLA LIAB X OCCUR 13273331 09/01/2012 09/01/2013 EACH OCCURRENCE $ 5,000'000 <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 <br /> DED RETENTION $ $ <br />D WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY WC043464600 (FL) 09/01/2012 09/01/2013 X WC STATU- oTH- <br />LIM TS <br />F Y I N WC043464598 (CA) 0910112012 09/0112013 _ 1 <br />000 <br />000 <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE <br />? N N / A E.L. EACH ACCIDENT , <br />, <br />$ <br />F OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) WC043464599 (MA, ND,OH,WA,WY) 09101/2012 09/0112013 E.L. DISEASE - EA EMPLOYE $ 1'000'000 <br />C under <br />yes, WC043464601 (ADS) 09/0112012 09101/2013 1 <br />000 <br />000 <br /> OF OPERATIONS below <br />DE E.L. DISEASE - POLICY LIMIT ' <br />' <br />$ <br /> <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) <br />Re: Site #: LA0623B -1528 South Standard Ave., Santa Ana, CA 92707. <br />Where required by written contract, Certificate Holder is an Additional Insured (except on Workers' Comp) as respects operations of the' Nereed lnsuied. Where requ red by wNtern egnffa1h above referenced <br />policy(s) includes Waiver of Subrogation in favor of the Certificate Holder. <br /> <br /> <br />GANGtLLA 1 IV N <br />City of Santa Ana-City Attorneys Office <br />20 Civic Center Plaza (M-23) <br />PO Box 1988 <br />Santa Ana, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />of Marsh USA Inc. <br />William Hines <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD