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5STAR -1 OP ID: LP
<br />A OR° CERTIFICATE OF LIABILITY INSURANCE
<br />`..,,.. /'
<br />DATE / 02/21/2014
<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 pollcy(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
<br />Jacksont Jacks 66 Insurance
<br />2220 East Route 66 Ste 205
<br />Glendora, CA 91740
<br />Chris E. Vandermeulen
<br />CONTA T Lori Patterson
<br />PHONE FAX
<br />(Auc No Ext:626- 914.9944 ac Ne:626- 914.1040
<br />AIL
<br />ADDEM RESS:
<br />'INSURERS AFFORDING COVERAGE
<br />NAIC Ii '
<br />INSURERA:Hartford Fire Insurance
<br />19682
<br />INSURED 5 Star Elevator Services, Inc.
<br />INSURERS: National Union Fire of PA
<br />19445
<br />1556 N. Case Street
<br />Orange, CA 92867
<br />INSURBRC: Preferred Employers
<br />10900
<br />INSURERO:Sentinel Ins. Co Limited
<br />11000
<br />INSURER E:
<br />02/25/2015
<br />DAMA RENTED
<br />PREMISES Eaoccurrence
<br />INSURER F:
<br />MED EXP (Any one person)
<br />COVERAGES CFRTIFIrtATFNIIMRPP- REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BE- ,JSSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTI2P T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC[E,S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY1PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />NSR
<br />BUSH
<br />POLICY NUMBER
<br />MMIDIDIYYYY
<br />POLICY SKIP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,006,006
<br />A
<br />X COMMERCIAL GENERAL LIABILITY.
<br />X
<br />X
<br />13UENOJ6085
<br />02/25/2014
<br />02/25/2015
<br />DAMA RENTED
<br />PREMISES Eaoccurrence
<br />$ 360,000
<br />MED EXP (Any one person)
<br />$ 10,006
<br />CLAIMS -MADE X OCCUR
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGO
<br />$ 3,000,000
<br />$
<br />POLICY X PRQ LOC
<br />AUTOMOBILE LIABILITY
<br />EO BINE tSINGLE LIMIT
<br />$ 1,060,600
<br />BODILY INJURY (Per person)
<br />$
<br />D
<br />ANY AUTO
<br />13UENOJ6085
<br />02/2512014
<br />02125/2015
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS NON -OWNED
<br />X HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />PER ACCIDENT
<br />$
<br />$
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />AGGREGATE
<br />$ 5,000,000
<br />B
<br />X
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />EBU016483148
<br />02/25/2014
<br />02125/2015
<br />DED I X I RETENTION NIL
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED4
<br />(Mandatory in NH)
<br />NIA
<br />WKN144421 -3
<br />- 08/01/2013
<br />08/01/2014
<br />X WC STALL) OTH-
<br />TOBY TS
<br />E. L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE, EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,006,660
<br />H'0' 61 desedba andor
<br />DES CRIPTION O F OPERATIONS below
<br />DESCRI PTION OF OPERATIONS LOCATIONS I VEH IDLES (Attach ACORD 101, Additional Remarks Schedule, if more space is renal red) -
<br />RE: Project #13 -070 — Elevator Maintenance. The City of Santa Ana, 20 3 Ji. "�� i '[0
<br />Civic Center Plaza, Santa Ana, CA 92701; its officers, employees, ag,, pWpR.4�
<br />volunteers and representatives are named as additional insureds with regard
<br />fo general liability and defense of suits arising from the operations and
<br />uses performed by or on behalf of the named insured, per attached (over) `_,��, //{/ . -• - - --
<br />- -Si
<br />9,auxa t[ eljdY.
<br />Assistant City AttOT "�t"
<br />CERTIFICATE HOLDER CANCELLATION
<br />"
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M -36
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />i
<br />© 1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010/05) The ACORD name and logo are - registered marks of ACORD
<br />
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