|
RINCCON•01 MANAWILM
<br />AC't3h'CX CERTIFICATE OF LIABILITY INSURANCE
<br />�-^""•
<br />OA11118/2014Y}
<br />11/18/2014
<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 .INSURE C7,.the peilcy(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 />certificate holder In lieu of such endorsement(s).
<br />PRODUCER License # OE67788�NAMTI
<br />Legends Environmental Ins. Services
<br />110 Vantis, Suite 250
<br />Aliso Vlajo, CA 82695
<br />r Ryan Jac: Los
<br />PHONE'
<br />gyp,,<a;(800)992.6999 �Ai No: 800 909.3957
<br />Aoogsss: Ryan.Jacquesaloausa.com
<br />INSURERIS)AFPORDING COVERAGE
<br />NAIO #
<br />INsuRERA:Crum&Forster SpecialtylnsuranoaCompany
<br />44520
<br />INSURED Y
<br />INSURERa:
<br />5 3,000,000
<br />INSVNARC:
<br />CMS�MADE OX OCCUR
<br />LPI
<br />Macon Consultants, Inc.
<br />_
<br />INSURER D:
<br />EPKAD5307
<br />210 N Ashwood Ave
<br />Ventura, CA 93033
<br />_
<br />INSURERS:
<br />8 50,040
<br />INSURER P':
<br />X Pollution Liability
<br />COVERAGES CERTIFICATE NUMBER:. REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPOLICY 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 SUBJECTTO ALL THE TERMS,,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN. MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />I SR
<br />T
<br />TYPEOFINaURANCE "-TN
<br />SBIVO
<br />POLICYNUMSER
<br />MMO bO�
<br />MMI�O Y
<br />_ Umn's
<br />A
<br />X COMMEnCS498{tE-Rfc4LUMNL#i'Y
<br />y.
<br />EACH OCCURRENCE
<br />5 3,000,000
<br />CMS�MADE OX OCCUR
<br />LPI
<br />X
<br />EPKAD5307
<br />09/22/2014
<br />-091224:edtfi'
<br />PRE I•Es E�aLap>
<br />8 50,040
<br />X Pollution Liability
<br />Aca
<br />MED EXPIAeyooepereun)
<br />5 10,000
<br />y. Tran5pO1'tat{On Pol.`
<br />t
<br />PERSONAL &ADV INJURY
<br />$ _ 3,000,000
<br />u
<br />GEML AGGREGATE LIMIT APPLIES PER: _
<br />GENERAL. AGGREGATE
<br />® 4000,000
<br />X POLICY PRO LOG
<br />ECT
<br />PRODUCTS-COMP/OPAGG
<br />§ 40DO,000
<br />_
<br />OlHeRl
<br />Trans . PoIL'I
<br />5 1,000,000
<br />-AVTOMOBILe LIAaltn'Y
<br />co Ds1NGLE MI
<br />BODILY INJURY (Pee pnrsan)
<br />S
<br />ANY AUTO
<br />AALL
<br />UTOS OWNED AUTOS SCHEDULED
<br />00011YINJURY(Per acciden)
<br />$
<br />PR EATYDAMvGG'
<br />NONLOWNcD
<br />HIRED AUIDs AUTOS
<br />a
<br />UMBRELLA LIAR X OCCUR
<br />-...
<br />EAGIf_OGCURRENCE
<br />5. 9,000,000
<br />4,,,REGATE
<br />S 5,000,00
<br />A
<br />X
<br />EXCESS LAE CLAIMS -MADE
<br />X
<br />�EFX,101817
<br />0972212014
<br />�OSI22W15`
<br />ED X RETENTION• 10,000
<br />_
<br />WORT ERS COMPENSATION
<br />EE
<br />AND EMPCOYERB' LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ❑
<br />OFFICERAGeMBER EXCLUDED?
<br />NIA
<br />E.L.EACHACCIOEAH
<br />$ --
<br />(MaudatorylnNH}
<br />EL. IXSEASE-EA EMPLOYE
<br />$.
<br />If yes, descdtie ondal
<br />DE SCRIPTION OF OPERATIONS below
<br />,�. .....
<br />E.L. DISEASE -POLICY LIMIT
<br />.$
<br />A
<br />Professional Llab.*
<br />EPK-105357
<br />09/2212014.'09122/201fi
<br />Included in Above GL
<br />BE$CRIPTION OF OPERATIONS I LOCATIONS I VEHICLE$ (ACORD 101, Addulonal Remarks Schedule, may Be attached if more space Is required)
<br />-The City of Santa Ana, its officers, employees, agents and volunteers are included Be additional Insureds with regard to liabli ty and defense of suits arising
<br />from work performed by or behalf of the named insured. General Liability is Primary and Nan -Contributory. 30 days notice of cancellation except for 10 days
<br />for non-payment of premium. AX
<br />CERTIFICATE HOLDER CANCELLATCON
<br />O 1988.2014 ACERB CORPORATION. All rights. reserved.
<br />ACORD 25 (2014/01) Tho ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCEI.LED BEFORE
<br />THE. EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE. POLICY PROVISIONS.-
<br />AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />_.. _ISUIptut Ana CA 92702
<br />I
<br />O 1988.2014 ACERB CORPORATION. All rights. reserved.
<br />ACORD 25 (2014/01) Tho ACORD name and logo are registered marks of ACORD
<br />
|