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178504 Servando Varela Elba XV Solutions
<br />Certificate of Insurance
<br />:;SII~_ 2[.
<br />(page 1 of 1) 01/19/2015 08;23:11 AM
<br />A1?1:)r CERTIFICATE LIABILITY INSURANCE
<br />DA E(MMIDDf YY)
<br />Ikk�THIS
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />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
<br />CONTACT
<br />NAME:
<br />000 Techlnsurance
<br />PHONE 800-668-7020 FAX
<br />IA/G Ne ex._tp,Al ..Nol: (877) 826-9067
<br />0' 1301 Central Expy. South, Suite 115
<br />1301 Tech Insurance
<br />E-MAIL
<br />Allen, TX 75013
<br />PRODUCE112-_ ._w-. _......--
<br />GUST _fN1.�R, to #: ...-.. _...... _ ..,._ .............
<br />INSURER(5) AFFORDING COVEf_AGE MAIC #
<br />........ - ...._
<br />INSURED
<br />INSURER A: Sentinel Insurance Company, Limited 11000
<br />Servando Varela dba XV Solutions
<br />INSURER B: Hartford Fire Insurance Company 19682
<br />3414 'Orange Blossom
<br />ww
<br />Irvine, CA 92618
<br />INsuRER C :
<br />_
<br />INSURER D:
<br />INSURER E.:
<br />INSURER F::
<br />%I U 4' r_ MIA U GJ GiEk11HUAIE NUMB'ER'. RC\IIQlnAl All IKARCQ..
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE -1 - 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 />I ...._'. POLICY EEE POLICY EXP
<br />LTR TYPE OF I'NSURANCE.. WVDPOLICY NUMBER IMMIDDfYIYM MM1DDIYYYY LIMITS
<br />GENERAL. LIABILITY
<br />EACH OCCURRENCE. $ 2,000,000
<br />✓ COMMERCIAL GENERAL LIABILITY
<br />QAMP,GJE T RENTED .....- 1,040,440 �
<br />PRwEMISES
<br />✓�
<br />-ERE-CEa occurrence _L
<br />CLAiM5-MADE OCCUR
<br />EXP (Any one person) $, 10,000
<br />A
<br />Yes
<br />46SBMUV8485 512812414
<br />972812015PERSONAL
<br />&ADV IN,IiURY $, 2,000,000
<br />..._
<br />GENrRALAGGREGATE S 000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PERS
<br />PRODUCTS - C2MP1OP AGG S 4,400..000 .......�.
<br />"✓ POLICY PRO-..
<br />JECT LOG
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT '.
<br />.._..
<br />tEa accident) S
<br />ANY AUTO
<br />BODILY INJURY (Per person) _ -s
<br />__.._.._
<br />--
<br />',..
<br />ALL OWNE:DAUTOS
<br />m_ .......
<br />BODILY INJURY (Per accident) $
<br />-......_.
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE $
<br />HIRED AUTOS
<br />(Per accident)
<br />NON-OWNFr7 AUTOS
<br />S
<br />5
<br />UMBRELLA LIAR OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS UAB .CLAIMS-MA�E'...
<br />AGGREGATE S
<br />DEDUCTIBLE
<br />S
<br />RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />WC —STAT U- OTH-
<br />AND EMPLOYERS` LIABILITY YIN
<br />T : RY 1 ,$......I ER
<br />ANY PROPMETORIPARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT S
<br />_..w
<br />OFFICER/MEMBER EXCLUDED?
<br />N f A
<br />�,....
<br />E.L. DISEASE - FA EmPLC S
<br />(Mandatory in NH)
<br />If yes.. describe under
<br />ff .
<br />.-.. .... .w-.
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $
<br />B
<br />Professional Liability (Errors and Omissions)
<br />46TE0288286
<br />111312©15
<br />1/10/2016
<br />Occurrence f Aggregate $1,000,000 1 S1„000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101., Additional Remarks Schedule, if more space is required)
<br />Operations pertaining to named inured for cert'holder, City of Santa Ana and its officers, agents, representatives, volunteers, & employees are additional insured f
<br />prim wrd as respects gen'I liab per eri CG7158 12/03&CG7253 9/05"30 day Should any of the above described policies be cancelled before the expiration
<br />date,the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non-payment) to the certificate holder named below, but failure to do'
<br />so shall impose no obligation or liability of any kind upon the insurer, Its agents or representatives.
<br />I 0v
<br />UER I II GA I Ic HOLDER CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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