|
1 •- a u
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />12111114
<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 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 endorsements .
<br />PRODUCER Phone: 949-5539800
<br />CONTACT
<br />NAME',
<br />The Woodltch Company Insurance Fax: 949-553-067
<br />Services, Inc.
<br />1 Park Plaza, Suite 400
<br />Irvine, CA 92814
<br />Chris Zehnder
<br />INCNa Ext(PAC. AZ:
<br />EMAIL
<br />ADDRESS,
<br />.................................
<br />AFFORDING COVERAGE NXICIF
<br />,,,,,,,,,,,,,,INSURER{S)
<br />INSURERA: (ronshore Specialty Ins. CO. 25445
<br />MED EXP {Any one peront .p 5,00
<br />14SLRM Service First Contractors
<br />INSURER B: Travelers Property Casualty Co 25674
<br />Network
<br />dbaServiceFirst
<br />NsuRERc:Insurance Company afthe West
<br />_27647
<br />2510 North Grand Ave, St 110
<br />INSURER D:
<br />INSURERE:
<br />Santa Ana, CA 92705
<br />rr)VPRAGES CFRTIFICATF NLIMRFR- REVISION NUMBER:
<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 />INSR
<br />ADDLSUBF TYPEOFINSURANCEPOLICY
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />EXP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X CCNe4ERCW. u^E R%tL4siLtir X
<br />C1 AMS -MADE 1 OCCUR
<br />Attn: PRCSA
<br />AG80002500
<br />11111194
<br />11111115
<br />EACHOCCLP.RENCE $ 1,000,0
<br />77=PREMISES Ea occwrenoa a 50,00
<br />MED EXP {Any one peront .p 5,00
<br />PERSONAL & APV INJURY $ 1,000,0
<br />GENERAL Ar GREGATC $ 2,000,0
<br />GEN'_ ACGREGATC LIMIT APPLIES PER:
<br />POLICY X PRO LOC
<br />PRODUCTS - COMP/OP AGC $ 2,000,00
<br />$
<br />AUTOMOBILE LIABILITY
<br />ANY AUl'0
<br />AUTOSNED SCHEDULED
<br />A TOS
<br />NON -OWNED
<br />HIRED AUTOS HAUTOS
<br />Ee accldent
<br />BODILY INJURY (Per person) $
<br />BODILY INJURY(Perecudont) $
<br />PROPERTY DAMAGE $�
<br />Per accident
<br />$
<br />B
<br />UMBRELLALIA8X
<br />X ExCEsSU B
<br />OCCUR
<br />c'CNCU:-MASEUP-51M19018-14-NF
<br />1Z
<br />11!11/14
<br />19111115
<br />EACH OCCLARRENCE $ SAOO,QO
<br />,ACGRECATE s 5,000,00
<br />UP WTENTI(NN
<br />C
<br />WORKERS COMPENSATIONWC
<br />AND EMPLOYERS' LIABILITY
<br />ANY OFFICFPoMF.MBERE-XCLUDEDXECUTVE Y❑ N/A
<br />(Mandatory In NH)
<br />Df'dbpn2f
<br />ESCR P' IQetiVYhP OF ORERATIONS bauw
<br />WED 502804400
<br />11/11/14
<br />11(11/15
<br />STATE TRILL
<br />X TORY LlM IG
<br />Et. EACHACCIDENT $ 1,000,00
<br />EL DISEASE - EA EMPLOYEEI 1,000,00
<br />E L DISEASE -POLICY LIMIT 1,000,00(
<br />Reviewed by:
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is roqulred) {
<br />*Except for 10 days notice of cancellation for non payment of premium. a.a
<br />All operations performed by the Named Insured during the current policy 1 .j�
<br />period. City of Santa Ana, its officers, agents, representatives, and Silvia Cuevas�{
<br />employees are included as Additional Insureds as respects General Liability RCSAIAdmin
<br />/form (- i
<br />per attached endorsement. **SEE NOTES** laipP
<br />SANTAA9
<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 />City of Santa Ana
<br />Attn: PRCSA
<br />20 Civic Center Plaza M-23
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana„ CA 92701
<br />o6o�
<br />@ 1999-2010 ACORD CORPORATION. Alt rights reserved.
<br />ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
|