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FIELDTURF-2016
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Last modified
5/30/2017 4:14:54 PM
Creation date
6/1/2016 10:20:18 AM
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Contracts
Company Name
FIELDTURF
Contract #
A-2016-105
Agency
Public Works
Council Approval Date
5/3/2016
Expiration Date
5/5/2017
Insurance Exp Date
9/28/2016
Destruction Year
2022
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A�coRG7® CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 <br />DATE (MM/DD/YYYY) <br />04/29/2016 <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 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 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 <br />CONT4AMACT <br />Willis of Pennsylvania, Inc. <br />c/o 26 Century Blvd. <br />P. O. Box 305191 <br />PHONE 877-945-7378 FAX ggg_467-2378 <br />) <br />E-MAIL certificates@willis.com <br />Nashville, TN 37230-5191 <br />INSURER(S)AFFORDINGCOVERAGE ''.. NAIC# <br />INSURER A: XL Insurance America, Inc. ''.24554-003 <br />INSURED Fieldturf USA, Inc. <br />INSURER B: Travelers Property Casualty Company of Am. 25674-008 <br />INSURER C: Travelers Indemnity Company 25658-001 <br />7445 Cote-de-Liesse Road, Suite 200 <br />Montreal, QC H4T 1G2 <br />Canada <br />INSURER D: The Charter Oak Fire Insurance Company 25615-001 <br />INSURER E: <br />INSURER F: <br />I <br />COVERAGES CERTIFICATE NUMBER: 24368464 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 />TYPE OF INSURANCE <br />DDL <br />SUB <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPITR <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />US00010327LI16A <br />5/1/2016 <br />5/1/2017 <br />EACHOCCURRENCE $ 11000,000 <br />CLAIMS -MADE OCCUR <br />PAng j??ENTED ) <br />aoccurence $ 100,000 <br />MED EXP (Any one person) $ 10,000 <br />PERSONAL&ADV INJURY $ 1 000 000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- D LOC <br />JECT <br />GENERALAGGREGATE $ 2,000,000 <br />j{ <br />PRODUCTS-COMPlOPAGG $ 2,000,000 <br />Is <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY <br />TJCAP823K312ATIL15 <br />9/28/2015 <br />9/28/2016 <br />COMBINED SINGLE LIMIT <br />(Eaaccident) $ 2,000,000 <br />BODILY INJURY(Perperson) $ <br />X ANY AUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY(Peraccident) $ <br />_ _ _ <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />I <br />ROPERTY DAMAGE <br />(Per accident) $ <br />X $1,000 X $1,000 <br />Coll Ded Comp Ded <br />- <br />$ <br />UMBRELLALIAB <br />OCCUR <br />i <br />EACH OCCURRENCE <br />Ll <br />-77T$ <br />AGGREGATE Is <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED RETENTION$ <br />i <br />$ <br />C <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTNERtEXECUTIVEX <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />f yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />AOS TC2HUB823K310615 <br />** TROUB823K311815 <br />9/28/2015 <br />9/28/2015 <br />9/28/2016 <br />9/28/2016 <br />X PER H -I <br />.STATUTE_ .ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />_ <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additonal Remarks Schedule, may be attached if more space is required) <br />WC Policies: AOS -covers all other states. **-covers AZ, MA, OR, WI only. <br />Project: Dan Young Turf Replacement <br />$1000 DBa" _.-._ <br />w i.UNld E F iff FI_t)lA (3�c� � OF <br />11 NO <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 />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Coll : 4892257 Tp1: 2051951 Cert : 24368464 O 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />
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