|
BTO
<br />CERTIFICATE OF LIABILITY INSURANCE R045
<br />DATE(MM/DD/YYYY)
<br />8/6/2015
<br />THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED, subject to the
<br />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
<br />BB &T INS SVCS OF CA INC /PHS /ORANGE
<br />CONTACT
<br />NAME:
<br />PHONE
<br />(ac,Ne,E�). (8 66) 967 -8730
<br />FAX
<br />tac,No): (888) 443 -6112
<br />ADDRESS:
<br />180672 P: (866) 467 -8730 F: (888) 443 -6112
<br />INSURERS) AFFORDING COVERAGE NAIL#
<br />PO BOX 33015
<br />INSURER A: Sentinel Ins Co LTD
<br />SAN ANTONIO TX 78265
<br />INSURED
<br />INSURERS: Hartford Accident & Indemnity Co
<br />INSURER C:
<br />INSURER D:
<br />LYNN CAPOUYA INC
<br />INSURER E'.
<br />$1, O 0 O I 000
<br />17992 MITCHELL S STE 110
<br />INSURER F:
<br />al Liab
<br />IRVINE CA 92614
<br />UUVCKA"r_* 1 v.- ...- ......,.. —
<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
<br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />JNSR
<br />SUBR
<br />III
<br />POLICYNUMBER
<br />POLICYEFF
<br />MAI/DD
<br />POLICYEXP
<br />LIMITS
<br />EACH OCCURRENCE
<br />s2 , 000, O O O
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occunenca)
<br />$1, O 0 O I 000
<br />qXGener
<br />A
<br />al Liab
<br />72 SBA KN6524
<br />07/10/2015
<br />07/10/2016
<br />X
<br />MED EXP (Any one person)
<br />$10, 000
<br />PERSONAL & ADV INJURY
<br />s2,000, 0 0 0
<br />GENERAL AGGREGATE
<br />s4, 000, 0 0 0
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO LOC
<br />JECT
<br />OTHER:
<br />PRODUCTS - COMPIOP AGG
<br />s4, 000, 0 0 0
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$1, 0 0 0, 000
<br />BODILY INJURY (Per person)
<br />$
<br />X ANY AUTO
<br />BODILY INJURY (Per accident)
<br />$
<br />B
<br />— ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />`X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />72 UEC AH1867
<br />07/2C/2015
<br />07/20/2016
<br />PROPERTY DAMAGE
<br />(Per - den"
<br />$
<br />S
<br />X
<br />UMBRELLA L(AB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$1 , 0 00 , 0 0 0
<br />AGGREGATE
<br />$1, 000, 000
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />72 SBA KN6524
<br />07/10/2015
<br />07/10/2016
<br />OEO X RETENTION 5 10 0 0 0
<br />WORKERS COMPENSA 110N
<br />AND EMPLOYERS'LLIBILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? a
<br />(Mandatory In NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />_
<br />X STATUTE ER
<br />$
<br />B
<br />72 WEC RROB14
<br />08/01/2015
<br />08/01/2016
<br />E.L. EACH ACCIDENT
<br />$1,000, O O O
<br />E.L. DISEASE -EA EMPLOYEE
<br />1, 000, 000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000, 0 0 0
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Atlditlanal Remarks Schedule, may be attached if more space is required)"'" vy "` „
<br />Those usual to the Insured's Operations.
<br />Jose , ty ttoill '
<br />1 C AsSis
<br />wT •I
<br />CERTIFICATE HOLDER
<br />The City Of Santa Ana, officers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
<br />Employees, Agents, Volunteers and DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Representatives AUTHORIZED REPRESENTATIVE
<br />20 CIVIC CENTER PLZ / ,& .
<br />SANTA ANA, CA 92701
<br />O 1988 -2014 ACORD CORPORATION. All rights rt
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|