Laserfiche WebLink
A` °R°® CERTIFICATE OF LIABILITY INSURANCE D 3 /2013 <br />/6 6'MMJDDJYYYY) <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 TE 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(les) 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 <br />NAME: 'a'mY Alberding <br />SPIB Insurance Agency, Inc. PHOI� (949)582 -5220 FAx <br />AIC N <br />License Number 0719264 o:(949)582 -3512 <br />amy @spib.com <br />26441 Crown Valley Parkway #200 <br />MLSSiOII Viejo CA 92691 INSURER(S) AFFORDING COVERAGE f4l Is <br />INSURERA:Peerless Insurance Co <br />INSURED <br />INsuRERB:The Netherlands Insurance Co Rue Vac Property Ser vices Inc INSURERC:Golden Ea le Insurance Co 600 W. Taft Avenue INSURERD:State Insurance Fund <br />l / II'1JV1{CR C <br />Orange CA 92865 I�O // —V tL «.Jf INSURER <br />COVERAGES CERTIFICATE NUMBER:3MSTR 13 -14. INCR. UMB 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 />IN <br />LTR TYPE OF INSURANCE POLICY NUMBER MMJDOO�Y MMIOOIYYYV LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1, 00,000 <br />X COMMERCIAL GENERAL LOBfLITV PREM SES Ea occurr<nro $ 100,000 <br />A CLAiMSn1ADE OCCUR BP9558563 /1/2013 /1/2014 MFD EXP (Any one parson) $ 5,000 <br />PERSONAL 6 ADV INJURY $ 1,000,000 <br />GENERAL AGGREGATE $ 2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER <br />X POLICY P R 7 LO" <br />PRODUCTS - COMP /0P AGG $ 2,000,000 <br />AUTOMOBILE LIABILITY WMCilt7 poNGLC LMii <br />X Fa arr..dnnl AtJV 11000,000 <br />B AU'C BODIL'i INJURY (Fer person) $ <br />AUTOS AUTOS SCHECULED 797086 /1/2013 /1/2014 <br />){ NON -ONMED BODILY INJURY (Par acc�ienq $ <br />HIRED ALIT -.s X AUTOS PROPERTY CAMAGE <br />Per a: GC?rd <br />X COMP PER SCH X CCLL PER S .H <br />UMBRELLA UAB [I OCCUR <br />UrKJenr r <br />;umd metot arooerty $ <br />EACH OCCURRENCE $ 2.000.000 <br />C X EXCESS LIAR CLAIMS.MADE AGGREGATE $ 2,000,000 <br />DED I I RETENT ION $ C119558863 /1/2013 /1/2014 <br />D WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YtC S7ATU- OTH- <br />AtdY PROPRIETOR!PARTT�ER�ENECUTIVE V / N <br />X TOR' I AITR R <br />OFFICEFL'MEMBER ExCLL:DECY? ❑ NIA EL EACH ACCIDENT $ 1 000 000 <br />(Mandatory In NH) 038319 -13 /1/2013 /1/2014 <br />it yes. CesmDa unAa- EL DISEASE- EAEMFLOYE $ 1,000,000 <br />DESCRI-TION OF OPERATIONS De4ow <br />E L DISEASE - POLICY LIMIT $ 11000,000 <br />A PROPERTY, SPECIAL FORM BP9558563 /1/2013 /1/2014 <br />BUILDING 1'248,480 <br />REPL.COST $1000 DID <br />BUSINESS FEP,S PROPERTY 104,040 <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace la required) RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA. <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS <br />ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM CG2010 07/04 AND CG2037 07/04, <br />PER WRITEN CONTRACT PRI"p"�i Vt9yT k]RU'11( Foy fWgR?* IS PROVIDED IN FORM # 22 -111 01 /07. <br />CERTIFICATE HOLDER Laura St Shccd CANCELLATION <br />Assistant City Attorne} <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />THE CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CAL 92701 AUTHORIZED REPRESENTATIVE <br />L Hines , CPCU ARM CLU —K iwy,► <br />ACORD 25 (2010/05) <br />INS025 i olooslo' O 1988 -2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />