|
11,4"-ld_ 404 drD
<br />OP IDP At;
<br />CERTIFICATE OF LIABILITY INSURANCE05101
<br />DATDIYYYI')
<br />05/01/14
<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(les) must be Endorsed. if SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of tho policy, certain policies may require an endorsemarrL A statement on this certificate does not confer rights to the
<br />cortlfieate holder in lieu of such ondorsemenY s .
<br />PRODUCER Phone: 949.553.9800
<br />The Wooditch Company Insurance ServiceFax: 849-553-0670
<br />1 Parks PlaIncza,
<br />1 Park CA 92 Suite 400
<br />Christ ph 92814
<br />Christopher Hodson
<br />COON
<br />PHONE
<br />AIC Nn:
<br />�E,dh
<br />ab ess:
<br />pnOD CEn
<br />1LSTOMEa IDa PAULU�1 ry_^
<br />INSURER(SI AFFORDING COVERAGE NAIC0
<br />GENERALNARIUTY
<br />X COMMERCIAL. GENER�AL u�nDlLrrr
<br />CLAMS -MAPF 1 OCCUR
<br />INSURED Paulus Engineering, Inc.
<br />___
<br />INSURER A: WOSCO Insurance Compan 25011
<br />2871 E. Coronado Street
<br />Anaheim, CA 82808
<br />INSURER e,Security National Insurance Co 19878
<br />INSURERC;
<br />INSURERD:
<br />S 1,000,00
<br />_ 00
<br />s 100,00
<br />_
<br />INSURER E:
<br />$ 5100
<br />INSPIRER P
<br />$ 1,000,00
<br />COVERAQFR CERTIFICATE NO IMRFR. RF1ne1nu hil IIIBn Cb.
<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 PMD CLAIMS.
<br />ILSR
<br />TYPE OE INSURANCE
<br />POUOV UMHER
<br />P U Y FF
<br />D
<br />PO CY CAP
<br />_
<br />LIMITS
<br />W.
<br />GENERALNARIUTY
<br />X COMMERCIAL. GENER�AL u�nDlLrrr
<br />CLAMS -MAPF 1 OCCUR
<br />X
<br />P108493701
<br />05101114
<br />06I01f1fi
<br />EACH OCCURRENCE
<br />- T2TRENTED._......._
<br />rs I OPSS,4H?,
<br />S 1,000,00
<br />_ 00
<br />s 100,00
<br />MCO EXP (Aev anh a eon)
<br />$ 5100
<br />PERSONAL A ADV INJURY
<br />$ 1,000,00
<br />�,�__,-,-.__
<br />GENERALAGGREGATE
<br />$� 2,000,00
<br />GeNL AGGREGATE
<br />LIMIT APPLIES
<br />PER:
<br />PRODUCls-COMPIOPAGG
<br />$ 2,000,00
<br />POLICY
<br />X PR
<br />LOC
<br />��
<br />7
<br />A
<br />AUTUMORILELIABILDY
<br />X
<br />ANY AUTO
<br />ALLOWNEOAUTO$
<br />WPP109493701
<br />08101114
<br />.pJ
<br />�y08/01/15
<br />y.>'_�(,A}
<br />COMBINED SINGLE LIMIT
<br />Ee aWdaM)
<br />$ 1,000,00
<br />BODILY INJURY(PatpArann)
<br />$ -�--
<br />OOOILY INJURY (per awitlen0
<br />S
<br />SCNEDULEDAUTOS
<br />HIRED AUTOS
<br />�yy p A
<br />S,O S
<br />'�
<br />PROPERTY
<br />PROPERTY DAMAGE
<br />$W_.
<br />S
<br />NONAWNEPAUTOS
<br />Vi.©
<br />K
<br />$
<br />UMBRELLA UAB
<br />IXCESH UAB
<br />_
<br />OCCUR
<br />GWMSMAnE
<br />r'I` SP �',•
<br />L1
<br />AI(t©C
<br />'M
<br />j
<br />J"
<br />EACH OCCURRENCE
<br />S
<br />___
<br />AGGREGATE
<br />$v
<br />DEDUCTIBLE
<br />$
<br />A55TStBnl
<br />$ �
<br />RETENTION
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS LIABILITY YIN
<br />ANY PROPRIETOWPARTNER/EXECURVE
<br />OPROERIMEMBER EXCLUDED?
<br />(M'ndaler1f In NH)
<br />it yyeA d06C(IhO aMaf
<br />DESCRIPTION OFOPERATIONS Wl*.
<br />NJA
<br />WC1045857
<br />05101114
<br />05101115
<br />WC STATLL 0
<br />X YJ.INB.S
<br />E,L.EACH ACCIDENT
<br />$ 1,000,Q0
<br />E1. DISEASE - EA EMPLOYEE
<br />$ 1,000,00
<br />E.L. OMEASC-POLICYLIMR
<br />1,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUe.h ACORD 101, Addeaeel R ... ft Schedule, Rmom space Is.,Wrerl)
<br />*Except 10 Days Notice of Cancellation for Non -Payment of Broalium.
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />roprespntaptives are Named as Additional Insureds as respects General -
<br />"Santa Ana Attached Endorsement. RE: Santa Ana EMSrgenay Work.
<br />g cY SEE NOTES glaip
<br />V L'R 11,'1l,MI C. I"INMIJ R �ArVUtj.1-AIiUIV
<br />SANTAAI
<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 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />220 S. Daisy Ave., M•85
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATNE
<br />�-
<br />G\9ORR.9nna ACnon PnOCMbAYIMI All.;—k6 .,.ae..ew
<br />ACORD 26 (2009109) Thu ACORD Rome and logo are ragistsmit marks of ACORD
<br />
|