|
1-7 -,. o iz. -060
<br />Client#: 1177321 SIGNATEC3
<br />SCORED CERTIFICATE OF LIABILITY INSURANCE
<br />DATE31/2❑I14
<br />12!31/2094
<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 BYTHE 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 rlghts to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />USI Insurance Sery LLC•WG SCL
<br />301 W. Warner Rd Suite 113
<br />Tempe, AZ 65264
<br />480 351.4438
<br />NA E, Toni King
<br />Alc o E,), 480-09-0966 ac Nq:
<br />nooaess: tonLkingQusl.biz
<br />INS URSRbArFORDINOCOVE RARE NAIL#
<br />INSURER A; Massachusetts Bay Insurance Com 22300
<br />INSURED
<br />Signature Technology Group
<br />INSURER B: Underwriters at Lloyd's London 15792
<br />Federal Insurance Company 20
<br />INSURER C; p y 281
<br />2424 W Desert Cove Ave
<br />Phoenix, AZ 65029
<br />INSURER D: Chubb Group of Insurance Compan 41386
<br />INSURER E: Twin City Fire Insurance Compan 29459
<br />INSURER P: Allmerica Financial Benefit 41640
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 REI,DUyyC��EpppDp BY PAID CLAIMS.
<br />1LTR
<br />TYPSOFINSURANCE
<br />INSR ADOL
<br />Me
<br />POLICY POLICY NUMBER
<br />MMID�IYYYY
<br />&.'C1 EXP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ® OCCUR
<br />OD4941575903
<br />1101/2015
<br />011,01/201E
<br />EEAACrpHpGOCCURRENCE
<br />PREMISES aour�nce
<br />_$1000000
<br />$306000
<br />MRD EXP (AnY one Pveon)
<br />$5,000
<br />PERSONAL B AOV INJURY
<br />$1,000,000
<br />GENERALAGGREGATE
<br />$2.000,000
<br />GEN'LAGGREGATE
<br />X POLICY
<br />LIMIT APPLIES
<br />,ECT
<br />PER.
<br />LOC
<br />PRODUCTS -OOMPIOP AGED
<br />$2,000,000
<br />F
<br />AUTOMOBILE
<br />X
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON-0WNED
<br />AUTOS
<br />AW4941575703
<br />1/01/2015
<br />01/01/201
<br />EO`cNJEDrSiN'_ LIMn
<br />1,000,000
<br />BODILY INJURY person(
<br />$
<br />BODILY INJURY Par nccldent
<br />BODI I
<br />$
<br />PROPERLY DAMAGE
<br />PBroccide I
<br />$
<br />A
<br />X
<br />U URELLA LIAR
<br />EXCESS LIAS
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />OD4941575903
<br />111101/2015
<br />01101/201C
<br />EACH OCCURRENCE
<br />$5000006
<br />AGGREGATE
<br />$5,000,000
<br />DEB I X RETENTION $5000
<br />$
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIE70MRAR18WEXECUTIVE
<br />OPPICERIMEMBER EXCLUDED? ❑
<br />(Mandabry In NH)
<br />Ir Ws, daecdhe undo,
<br />OE SC RIPTION OF OPERATIONS below
<br />NIA
<br />WC STATU- OTH-
<br />TORY La ITSER
<br />E, L. EACH ACCIDENT
<br />_
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />6
<br />EL LIMIT
<br />$
<br />B
<br />C
<br />D
<br />Professional
<br />Crime
<br />Em Practice
<br />UCS260146815
<br />82260585
<br />82409000
<br />01/01/2015
<br />10/291201410129!201
<br />7/01/2314
<br />011011201
<br />07/01/201
<br />IREASE-POLICY
<br />5,000,000
<br />1,DOO,ODO
<br />1,060,000
<br />DESCRIPTION OF OPERATIONS; LOCATIONS I VEHICLES (Attach AGOR❑ 131, Addlflonal Remarks Schedule, If more space Is requlraJ)
<br />City of Santa Ana, its officers, employees; agents, volunteers and
<br />representatives are additional insured for general liability per 391-1006
<br />06/09. Coverage is primary & non-contributory per 391-133106109. Waiver ,
<br />of Subrogation applies to general liability per BPD497.
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13PFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Lynda Kelly ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza M-12
<br />Santa Ana, CA 92701 1 AUTHORIZED REPRESENTATIVE
<br />0 1 98 6-201 0 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2090105) 1 of 1 The ADORED name and Ingo are registered marks of ACORD P .
<br />#$14062748/M14059956 TXKJB IfI j)/�
<br />
|