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JLFFENG -01 YUEI
<br />ACCJRp° CERTIFICATE OF LIABILITY INSURANCE �
<br />DATE 10 /151 0x15
<br />1011 15/2016
<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 VLI{F ' NOT_CpN §ThTUT€ A ONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERT(FICAT)E HOLDER? ) 7
<br />IMPORTANT: If the certificate holder Is an AS�PP ITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certalnip�rcns hiP'y fegGii2 an endorsement. A statement on this certificate does not confer rights to the
<br />cortificate, holder in lieu of such endorsomem ,
<br />(s).P I L
<br />PRODUCER License # 0E67768 I Naas `'� Glgi Yuen
<br />OA Insurance Services PHONE - 025 416 -7862 _
<br />5875 HoPyard Road Arc ) p +c Noi {g25} 41
<br />>ulto 240 E-MAIL s: Gigi.Yuen @ioausa.com
<br />°leasanton, CA 94588 _
<br />INSURED
<br />JLee Engineering, Inc.
<br />430 S. Garfield Avenue, #301
<br />Alhambra, CA 91801
<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 THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />I TYPE OF INSURANCE ADDL R POLICY NUM @ER MMID61'M MMIDD� LIMITS
<br />LTft
<br />A X
<br />I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
<br />2,900,000
<br />20 Civic Center Plaza, M -20
<br />CIA X, OCCUR 6808855NS94 09/0112015 09/01/2016 PREMISES rIoccurrence $
<br />1,900,000
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<br />MED EXP (Any one person)_ $
<br />10,000
<br />PERSONAL&ADVINJURY $
<br />2,000,09
<br />GEHL
<br />AGGREGATE LIMn- APPLIES PER GENERALAGGREf 1L $
<br />4,000,00
<br />POLICY j5RQr LOC PRODUCTS- COMP'GP AGG $
<br />4,000,000
<br />OTHER:
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
<br />Ee acclden0
<br />2,000,000
<br />A ANYAUTO 680886BN594 09/01/2015 0910112016 BODILY INJURY (Per person) $
<br />ALL OVITED SCHEDULED BODILY INJURY (Per scoli $
<br />AUTOS AUTOS
<br />X NGN- OCINED
<br />X . ROPEft� $
<br />VIREO AUTOS AUTOS JRdE acarent
<br />UMBRELLA LIAB OCCUR EACH OCCURRENCE $
<br />_
<br />EXCESS LIAB CLAIMS -MADE AGGREGATE $
<br />DED RETENr10N$ $
<br />WORKERS COMPENSATION X PER ER
<br />AND EMPLOYERS' LWBILrrY YIN
<br />A ANY PROPRIETORrPARTNEWEXECUTiVE UB329OT632 09/01/2015 09/0112016 E.L. EACH ACCIDENT $
<br />1,000,00
<br />OFFICERIMEMBER EXCLUDED? NIA
<br />(Mandatory In NH) E . DISEASE EA EMPLOYEE $
<br />1,000,09
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $
<br />1,000,000
<br />B Professional Liab. IAE1252603 11/02/2015 09/01/2016 Per Claim
<br />1,000,000
<br />B Professional Liab, IAE1252603 11/02/2015 09/01/2016 Aggregate
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS i LOCATIONS t VEHICLES (ACORD 181, Adetiunal Remarks Sah.mS. may be aaached R mere space is mquked)
<br />All Operations of the Named Insured.
<br />General Liability: See Additional Insured Endorsement attached; such coverage is Primary S Non - Contributory, as required per written contract.
<br />Workers' Compensation: See attached Waiver of Subrogation Endorsement attached. Waiver of Subrogation is in favor of the aforneentioned Additional
<br />Insured, as required per written contract.
<br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S):
<br />City of Santa Ana, its appointed and elected officers, officials, and employees and /or as required per written contract
<br />CERTIFICATE HOLDER CANCELLATION
<br />CO 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Suit,
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<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />Planning and Building Agency
<br />20 Civic Center Plaza, M -20
<br />•^A`* -^
<br />Santa Ana CA 92702
<br />.. , ..r.�...�.. _.....
<br />CO 1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Suit,
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<br />
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