Laserfiche WebLink
<br />ACORDTM CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE (MMIODIYY) <br /> 12/2812006 <br /> THIS CERTlRCATE IS ISSUED AS MATTER OF INFORMATION ONLY <br />PRODUCER AND CONFERS NO RIGHTS UPON THE CERTlRCA TE HOLDER. <br />Allianl Insurance Services, Inc. THIS CERTlACATE DOES NOT AMEND, EXTEND DR ALTER THE <br /> COVERAGE AFFORDED BY THE POUCIES BELOW, <br />The Transamerica Pyramid <br />i 600 Montgomery Street, cj" Floor INSURERS AFFORDING COVERAGE <br />San Francisco, CA 941 ] 1 <br />Phone: (415) 403- ] 400 Fax: (415) 402-0773 <br />INSURED INSURER A: NonProfits' United Workers' Compensation Group <br /> INSURER a Safety National Insurance CompllIlY <br /> Orange County Conservation Corps INSURER c' <br /> 1853 N. Raymond Ave <br /> Anaheim, CA 9280] -] ] 17 INSURER D: <br /> IN._URER E <br />COVERAGES Thl! Cenifleat.e 1$ not Intended to apKify .n endo".ments, CO'Iftrage.$, teons, condltionltild a>cctU!itornl of the policies stlOwn. <br /> TE5Cl;'TNSURANGI= LISTED BELOW HAVE BEEN I,.,.u~u IV AMI=D ABllVE'FDR 1 HE PULK. v PI=RluD INDiCATED, NUrwtl H:> I ANDING <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT Te WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN. THE iNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS EXCLUSiONS AND CONDITIONS OF SUCH <br />POLiCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAiMS, <br />INSR TYPE OF INSURANCE POUCYNUMBER POUCY POI..ICY L.lNlTS <br />LlR EFFEC1l\IE EXPIRATION <br /> DATE IMMlDDIYYl DATE IMMIOD/YY'I <br /> GENERAL UABlUTY EACH OCCURRENCE $ <br /> COMMERCIAL GENERAL LlABlLm' FlRE DAMAGE (1vTi one ilrej $ <br /> i <br /> I CLAiMS MADE I I OCCUR MEDEXPENSE~~ $ <br /> i PERSONAL I> ADV INJURY $ <br /> j GENERAL AGGREGATE $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG $ <br /> POLICY I I j:2; I I LOG <br /> AUTOMOBILE LUIIILl'IT COMBINED SINGLE LIMIT $ <br /> ANY AIITO ! (Ea 8GD0lln1) <br /> $ <br /> ALL OIM/ED AUTOS j BODILY INJURY $ <br /> SCHEOULEDAUTOS I (Per per.on) $ <br /> I <br /> HIRED AUTOS BODILY INJURY $ <br /> NON-OWNED AUTOS i {Per ac::ident,i <br /> $ <br />i I PROPERTY DAMAGE $ <br /> ! (Per amdenl) <br /> I S <br /> GARAGE UABIUTY AUTO OND' -Eel< ACCIDENT $ <br /> ANY AlITa OTliERTHAN I EA /'CD $ <br /> 1 AUTO ONLY' <br /> I N3G $ <br /> EXCESS L1ABIUTY i EACH OCCURRENC $ <br /> OCCUR I I CLAIMS MADE i AGGREGATE $ <br /> i $ <br /> DEDUCTIBle $ <br /> RETENTION I <br /> I I WORKERS' COMPENSATION AND i <br /> EMPLOYERS UABIUTY I ~STATU I XI OTt-f. <br /> NPU-WCGOO-2007 TORY LIMITS ER <br />A 1/l/07 l/LOE E,L EACH ACCIDENT .500,000 <br /> E.L DISEASE -EA EMPLOYEE $ 500,000 <br /> E.L DISEASE -POLICY LIMIT $ 500,000 <br /> OlHER <br />B Excess Worker's Compensabon SF-1F81-CA 111107 IIW8 $25,000,000 x $500,000 we <br /> $500,000 XS $500,000 EL I <br />DESCRIPTION OF OPERA110NSlLDCAl1ONS/llEHICLESlEXCWSIDNS ADDED BY ENOORSEMENTlSPEClALfPRDVISIONS <br />Evidence of Workers' Compensation Covcl'Ilge <br />CERTlFlCA TE HOLDER I I AODITIDNAL iNSURED; INSURER LETTER: CANCELLATION <br /> SHOULD ANJ V. tn" ""VY~ Ut~~KIOI;j) ~ CANCELLED acr' '"'' In~ tN'IKAIIUN <br /> NPU-OCCC-027 DATE THEREOf. THE ISSUING INSURER WLL ENDEAVOR 10 MAlL ~ M YS WRiTTEN NOTICE <br />Santa Ana WlA Administration Office TO THE CERTIFiCATE HOLDER NAMED TO TIiE LEFT, BUT FAilURE TO 00 so SHALl'MPOSE NO <br />J 000 East Santa Ana Boulevard. #200 OBUG...llQN OR UABIUTY OF "'NY KINO UPON THE INSURER. ITS AGENTS OR <br />Santa Anu, CA 9270] REPREliEHTAllVES. k I ___ <br />A1TN: Lydia Morgan AlITKORIZED REPRES'V"TIVE .....A G-Y+- <br />ACORD 25-$ (7T97) .... /ft' , <br />TO:\CSG\DO -- @ACORD CORPORATION 19 <br /> <br />DMA5TERS.Certlfic,a~ of Liability 1nswl.nce AC0RD2s..S.1 <br /> <br />88 <br /> <br />APPROVED AS TO FORM <br />--- <br />70'~ <br />i Lorena aloza <br />Assistant City Attorney <br /> <br />