|
A� R" CERTIFICATE OF LIABILITY INSURANCE
<br />HATE IMMlDD1YYYY)
<br />ATE(M
<br />�� 5/2017
<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(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />CONTACT Jonathan Thomas
<br />GISG Insurance Services LLG
<br />PHONE 415-946-7500 FAX 15-946-7550
<br />License f#0K19767
<br />32 Old slip A-2015-252
<br />EMAIL Jonathan.thomas@Mstalco.com
<br />ADDRM'
<br />INSURER S AFFORDING COVERAGE
<br />NAIL #
<br />New York NY 10005
<br />INSURERA:Natianal Fire Insurance Company of
<br />20478
<br />INSURED TTHOLD
<br />INSURER B;Valley Forge Insurance Company
<br />20508
<br />INSURER C: Continental Casualty Company
<br />20443
<br />Palermo TT Holdings, Inc.
<br />9477 Waples, Suite 100
<br />INSUR€RD:Indian Harbor Insurance CoTpanY
<br />36940
<br />San Diego, CA 92121
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:20053803351 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 />LTR
<br />TY'PE.OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM1DDIYYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />6024533045
<br />5/1/2017
<br />5/112018
<br />EACH OCCURRENCE..
<br />$1,000.,000
<br />X OCCUR
<br />DAMAGE
<br />PREMSESOEaaNccuo'ce
<br />$1,000,000
<br />_:ACLAIMS-MADE
<br />EXP IAny one person)_
<br />$15,000
<br />_MED
<br />PERSONAL BADVINJURY
<br />S1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />POLICY 1-1PRC- JECT [E LOC
<br />PRODUCTS - COMP/OP AGO
<br />$2,000„000
<br />$
<br />OTHER:
<br />A
<br />AUTC/Mf]BILEU
<br />6024533059
<br />5/1I2017
<br />5/112018
<br />C11ABILITY
<br />Ea accidentNED SINGLE LIMIT
<br />$1,000,000
<br />'BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />X
<br />BODILY INJURY (Per accident)
<br />$
<br />HVRED NON -OWNED
<br />AUTOS ONLY X AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB X OCCUR
<br />6024533093
<br />511/2017
<br />5/1/2018
<br />EACH OCCURRENCE,
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB CLAIMS -MADE
<br />DED RETENTION S
<br />$
<br />C
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />6024533062
<br />6024533076
<br />5/1/2017
<br />5/1/2017
<br />5/1/2018
<br />5/l /2018
<br />X IPER STATUTE ORH-,
<br />E,L EACH ACCIDENT
<br />$1,000.,000
<br />OFFICERIMEMBER EXCLUDED? u
<br />N / A
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />D
<br />Tech Professional Liab
<br />MTP9032.20002
<br />5/1/2017
<br />5/1/2018
<br />5,000,000 Each Claimloco.
<br />Retroactive Date 1/1/92
<br />5,000,000 Aggregate
<br />Claims Made
<br />100,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101„ Additional. Remarks Schedule, may he attached if more space is required)
<br />The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as Additional Insured as required by
<br />written contract, but limited to the operations of the Insured under said Contract, per the applicable endorsement with respect to the General
<br />Liability and Automobile Liability policies.
<br />CERTIFIGAT E HOLDERR,
<br />The City of Santa Ana
<br />60 CIVIC Center Plaza
<br />Santa Ana, CA 92701-0000
<br />ELLA I IUN
<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 />AUTHORIZED REPRESENTATIVE
<br />U 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
|