|
INFOS-1 OR M
<br />[]0�11127/2016
<br />THIS CERTIFICATE IS ISSUEDAS A, MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY ► AMEND,Orr BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOOI D
<br />REPRESENTATIVE OR PRODUCER, CERTIFICATE
<br />R.
<br />IMPORTANT:
<br />conditionsthe terms and Policy, I. may requirean endorsement.does
<br />certificate holder In lieu Of SUch r
<br />PRODUCERCONTAC TO'Connor
<br />r
<br />Fvcsriedmann
<br />PHONE
<br />CA L�cense #0759373, 8w
<br />.,0 Westerly Place Suite 100
<br />Newport .
<br />ADDRESS,
<br />INSURED INFO SEND, Inc.
<br />Rezai and Son, LLC
<br />4240 E. La Palma Arae
<br />Anaheim, CA 921807
<br />..-
<br />IINSURER A : Chu'hb Groaup or Insurance Co's
<br />INSURER 8 Axis Surplus InvuranCe Company ..26620
<br />INSURER C :
<br />COVERAGES CERTIFICATE
<br />NUMBERa
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES
<br />OF INSURANCE
<br />LISTED BELOW HAVE BEEN
<br />ISSUED TO
<br />THE INSURED
<br />NAMED ABOVE FOR THE
<br />POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY
<br />CONTRACT
<br />OR OTHER
<br />DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN,
<br />THE INSURANCE AFFORDED BY
<br />THE POLICIES
<br />DESCRIBED
<br />HEREIN IS SUBJECT TO
<br />ALL THE TERMS,
<br />EXCLUSIONS ANDCONDITIONS OF SUCH'
<br />POLICIES.
<br />LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY
<br />PAID CLAIMS.
<br />— _ ...... ......... ...............
<br />LTR INSTYPE OF INSURANCE
<br />eBdC�
<br />_. R
<br />S B
<br />.._._..._m ...°...,._ ...
<br />POLICY NUMBER
<br />POLICY EFF
<br />i' MlMLEr O/YYYY
<br />PC7LICY E%P ...
<br />MMfODfYYYY
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />j $ 1,0001,0
<br />CLAIMS -MADE. OCCUR
<br />56031149
<br />0212412016
<br />02/2412017
<br />i3ANTAGETC F�EY�TIEtS
<br />1,000,0
<br />PREM l�E,S I,Ea riceerr qe]..__
<br />$
<br />M...ED EXP' QArtIy erre Iperson)
<br />$ 1000
<br />PERSONAL & AP7U INJLdRY
<br />$ 1,000,0
<br />GENLAGGREGATE UMITAPPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,0
<br />..._ PRO-
<br />PC7LV4;Y JEG$' _ LOC
<br />....... ........... ----- -----
<br />PRDDUCTS-DOMPRDPAGG
<br />_.
<br />3 2,000,0
<br />_
<br />OT9-IR :
<br />S
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,0
<br />..(Fal accident
<br />A ANY AUTO
<br />T
<br />73587120
<br />02118120/6
<br />02118/2017
<br />BODILY INJURY (Per person)
<br />ALLOWNED SCHEDULED
<br />_ .., AUTOS AUTOS
<br />I
<br />BODILY INJURY (Par accidenkl
<br />;n
<br />NON -OWNED
<br />HIREDAUTOS ._.. AUTOS
<br />PROPERTY DAMAGE
<br />Ppr a€.crdp°P)_
<br />$ _._..., _,.,_.....
<br />UM.BRELLA..LIAB OCCUR.
<br />EACH0C..
<br />$ 5,000,0
<br />A EXCESS LIAR CLAIMs_MADE
<br />79896856
<br />0212412016
<br />02'/2412017
<br />AGGREGATE
<br />. ... . ...... . ... . ... ....CURRENCE . .. . . .......... .I
<br />$ 5,000,0
<br />CELT RF..TE.NTtlON.$
<br />$
<br />WORKERS COMPENSATION
<br />PER 'TH-
<br />AND EMPLOYERS' LIABILITY
<br />YE
<br />ER
<br />�__E:
<br />EACH ACCIDENT
<br />$ 1 000
<br />A ANY PROPRIETOR/PARTNER/EXECUITIVE
<br />v
<br />X
<br />71749812
<br />0210112016
<br />02101/2017
<br />EXCLUDED?
<br />N 1 A
<br />-°—
<br />(Mandatory
<br />In NH)
<br />(Mandatory ira NH)
<br />B.L. DISEASE EA EMPLC YE
<br />1,0000
<br />$ ,0
<br />It yes, describe
<br />DESCRIP-NON'..under
<br />OF OPERATIONS below
<br />..°E.L DISEASE POLIIDY-LlIM1T
<br />1 $---- 11,0010,0
<br />B Errors &Onilssions
<br />MCN000222831I501
<br />12101/2015
<br />12/0112016
<br />Lirnit
<br />5,000,0
<br />C/ed'ucti'13I',
<br />25,0
<br />DESCRIPTION OF OPERATIONS f LOCATIONS /'VEHICLES (ACORO 101, AddlflorW Remarks Schedule, maybe attached if more space is required)
<br />TheCott' of Santa Ana, 20 Civic Center plaza, Santa Ana, California 92701;
<br />its officers, employees agents, volunteers 'and representatives are hereby"II �r � �I (fill
<br />Warned as an additlona� insured with regards to General Liability,Waiver of w ° � r a °� �a �
<br />subrogation applies to workers compensation.
<br />SAN2003
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cit of Sang Ana. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE, POLICY PROVISIONS,
<br />G Box 19'54
<br />Santa Ana, CA 927012 AUTHORIZED REPRESENTATIVE
<br />-- — ------- lc>t� -
<br />01988-2014 ACORD CORPtORATICON. All rights reserved,
<br />ACCO C1 25 (2014101) The ACORD5 name and logo are registered marks ofACIO'p,
<br />
|