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178504, Servando Varela dba XV Scidutions Certificate of Insurance
<br />A . �- i '0? '
<br />(page 1 of 1) 02/1 1 /201 6 04144 PM
<br />ACCW?"DATE (MM/DD/YYYY)
<br />li.i CERTIFICATE OF LIABILITY INSURANCE 1 2/11/2016
<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 poli:cy(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 />I certificate holder in lieu of such endorsement(s).
<br />I PnooucEA I CONTACT
<br />000
<br />200* Tech Insurance
<br />TechInsurance800-668-7020
<br />1301 Central Expy, South, Suite 115
<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 />,A-GUL
<br />FAX No): (877) 826-9067
<br />(A/C,
<br />E-MAIL
<br />ADDRESS:
<br />SUB R
<br />POLICY NUMBER
<br />Allen, TX 75013
<br />POLICmY EXP
<br />(MM/DDNYYY)
<br />-
<br />V
<br />COMMERCIAL GENERAL LIABILITY
<br />INSURERS} AFFORDING COVERAGE
<br />NAIL i
<br />INSURER A:
<br />Sentinel Insurance Comgan �Limited�
<br />11000
<br />INSURED
<br />INSURER 8
<br />Fire Insurance CompAoy_...._
<br />19682
<br />Servando Varela dba XV Solutions
<br />DAMAGE TO RENTED 1,000,000
<br />INSURER C:
<br />..Hartford
<br />344 Orange Blossom
<br />Irvine, CA 92618
<br />INSURER E:
<br />MED EXP (Any one person) $ 10.000
<br />('nVFRAr.F.q r'FPTlIZIii KII IfiAnt:n- Dr-11101inkil Ell ]RADC0.
<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 />,A-GUL
<br />INSR
<br />LTH
<br />TYPE OF INSURANCE
<br />SUB R
<br />POLICY NUMBER
<br />POLICY EFF
<br />(Mi IYYYY)
<br />POLICmY EXP
<br />(MM/DDNYYY)
<br />LIMITS
<br />V
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE 2,100,000
<br />CLAIMS -MADE IV] OCCUR
<br />DAMAGE TO RENTED 1,000,000
<br />PRE $
<br />i og&[Tnce1--
<br />MED EXP (Any one person) $ 10.000
<br />. ...... ..
<br />A
<br />Yes
<br />46SBMUN0237
<br />613012015
<br />6/30/2016
<br />. ..........
<br />PERSONAL & ADV INJURY S 2..000'000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENT
<br />GENERAL AGGREGATE S 4,000,000
<br />PRO -
<br />POLICY JECT LOC
<br />F—P1C1u`G"TS—COMP1OP AGG S 4,n00,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />ANY AUTO
<br />BODILY INJURY (Per person) 5
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident) S
<br />AUTOS AUTOS
<br />NON -OWNED
<br />PROPERTY DAMAGE
<br />H I
<br />HIRED AUTO AUTOS
<br />tP" ""di
<br />UMBRELLA LIAR OCCUR
<br />EACH OCCURRENCE� $
<br />AGGREGATE $
<br />EXCESS LIAR CL A !YS --MADE
<br />—-DED
<br />� I RETENTION$
<br />S
<br />WORKERS COMPENSATION
<br />O TH
<br />AND EMPLY/N OYERS' LIABILITY
<br />_[PER
<br />STATUTE .-LRET1 RH--
<br />_—
<br />ANY PROPRIETORIPARTNERJEXECLJTIVENI
<br />. EACH ACCIDENT S
<br />OFFICERIMEMBER EXCLUDED? ❑A
<br />-EL.
<br />(Mandatory in NH)
<br />E�T. DISEASE - EA EMPLOYE S
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT 8
<br />DESCRIPTION OF OPERATIONS below
<br />3
<br />Professlonal Ljabilii (Errors and Omissions)
<br />46TED294403
<br />111312016
<br />111312017
<br />$1,000,000!$1,0001000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ll more space Is required)
<br />City of Santa Ana and its officers, agents, representatives, volunteers, & employees are named as Additional Insured as their interests may appear in regards to
<br />general liability. This insurance is primary and non-contributory to any other insurance provided! as respects general liability coverage. Should any of the above
<br />described policies be cancelled before the expiration date, the issuing insurer will endeavor to mail 30 days written notice (10 days notice if due to non-payment)
<br />to the certificate holder named below, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives.
<br />;,i i iriw-k i r- nVILUMM UAINULILLA I 1UN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />0 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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