|
OP ID: CL
<br />'4 . 'RG' CERTIFICATE OF LIABILITY INSURANCE
<br />DAT
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />01107D/YYYY)
<br />01 /07/12
<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 818-706-8680
<br />CONTACT
<br />Alia BezkrovnyPHONE
<br />30423 CANWOOD ST., SUITE 228 818-706-8689
<br />FAX
<br />A/C No Ext): AlC, No):
<br />AGOURA HILLS, CA 91301
<br />E-MAIL
<br />ALLA BEZKROVNY
<br />ADDRESS:
<br />PRODUCER WCSTRM-
<br />CUSTOMER ID #:
<br />A
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED WEST COAST STORM INC.
<br />INSURERA: ENDURANCEAMERICAN SPECIALTY IN 41718
<br />1188 LEISKE DRIVE
<br />_
<br />INSURERS: ARCH INSURANCE GROUP 11150
<br />RIALTO, CA 92376
<br />INSURERC:AGCS MARINE INS. CO.
<br />�$ CLAIMS
<br />INSURER D
<br />!
<br />INSURER E:
<br />INSURER F
<br />COVERAGES CERTIFICATF NIIMRFR• oGlneinu KI"11,11121=0
<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 />"SR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />1
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MMIDDlYYYY
<br />LIMITS
<br />AUTHORIIZEED,IREPRESENTATIVE
<br />GENERAL LIABILITY
<br />SANTA ANA, CA 92702-1988
<br />EACH OCCURRENCE $ 2,000,00
<br />A
<br />! X ! COMMERCIAL GENERAL LIABILITY
<br />ECC101004981-03
<br />01/10/12
<br />01/10/13
<br />DAMAGE TO RENTED ES Ea Ecco encs $ 50,00
<br />�$ CLAIMS
<br />-MADE OCCUR
<br />$ 5,00
<br />MED EXP (Any one person) $
<br />X CNTRCTRS POLLUTIO
<br />PERSONAL &ADV INJURY $ 2,000,00
<br />X PRFSSNL CLMS MADE
<br />RETRO DATE 01/17/07
<br />GENERAL AGGREGATE $ 2,000,00
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />-
<br />PRODUCTS -COMP/0P AGG $ 2,000,00
<br />PRO-JECT LOC
<br />POLICY )C1
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,00
<br />!-_--,
<br />ANY AUTO
<br />(Ea accident)
<br />-
<br />BODILY INJURY $
<br />B
<br />X
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />�FBCAT0099004
<br />01/11/12
<br />01/11/13
<br />(Per person)
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />$
<br />X
<br />HIRED AUTOS
<br />�X�
<br />(Per accident)
<br />NON -OWNED AUTOS
<br />$
<br />B
<br />rX
<br />BROAD POLLUTION
<br />IFBCAT0099004
<br />1 01/01/12
<br />01/01/13
<br />1 1 $
<br />$
<br />UMBRELLA LIAB
<br />�Xi OCCUR
<br />EACH OCCURRENCE i 1 $ 5,000,00
<br />r-- --+--------- —
<br />i
<br />A
<br />XCLAIMS-MADE
<br />I----
<br />EXCESS LIAB
<br />�----- ._ __ _.
<br />EX5101004982-03
<br />01!10/12
<br />01110/13
<br />AGGREGATE $ 5,000,00
<br />I -_ ---- --+$ - ---
<br />-
<br />DEDUCTIBLE
<br />X
<br />RETENTION $ 5000
<br />$
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY
<br />Y / NE.L.
<br />T R IMT ER
<br />_
<br />EACH ACCIDENT $
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />N ! A
<br />- E.L. DISEASE EA EMPLOYEE $
<br />'
<br />(Mandatory in
<br />If yes, describe aundnd er
<br />j
<br />E.L. DISEASE -POLICY LIMIT $
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />PHYS DMG/LSD-RNTDE
<br />FBCAT0099004
<br />01/11/12
<br />01/11/13
<br />DEDUCTBLE 1,00
<br />C
<br />CONTRACTORS EQUIPM
<br />MX193027679
<br />01/10/12
<br />01/10/13
<br />DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) A Y' � ,�
<br />ORANGE COUNTY AND THE CITY OF SANTA ANA AND THEIR OFFICERS, AGENTS AND
<br />EMPLOYEES AS ADDITIONAL INSURED PER FORM FEI-319-ECC-0708 AND DOES
<br />NOT APPLY TO PROFESSIONAL LIABILITY.
<br />-
<br />THIRTY DAYS WRITTEN NOTICE OF CANCELLATION.
<br />U 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />.,,...LL.L., I
<br />SAN 1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />PUBLIC WORKS AGENCY
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />DESIGN ENGINEERING
<br />AUTHORIIZEED,IREPRESENTATIVE
<br />P.O. BOX 1988, M-36
<br />SANTA ANA, CA 92702-1988
<br />U 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|