|
Policy Number: HHD 10015218
<br />Date Entered. 07/15/2016
<br />K" CERTIFICATE OF LIABILITY INSURANCE
<br />TE (MMADOM
<br />`
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />7/15/201
<br />7/15/2016
<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 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 INSUREp, the policy(ies) musf bo 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 IIEU of such endorsement(s).
<br />PRODUCER
<br />_
<br />CONTACT
<br />RITA M. PRICE INSURANCE AGENCY
<br />NAME;
<br />PO Box 189
<br />PHONE (909)937-2519 .._Pnz`___________
<br />(909)336-6989_
<br />Lake Arrowhead, CA 92352mAu
<br />aoogEss`P q cY.
<br />ERE musette,r rice@fa.rmersa en com
<br />PRODUCTS.GOMPOPAGGi41rOOO,DDD
<br />i I
<br />__ INSURERS) AFFORDING COVERAGE l NAICI
<br />-- ..��_.�._.._,____
<br />N
<br />INSURER A;1ItIDSON SPECIALTY INSURANCE COMP
<br />INSURED RACE CENTRAL
<br />ANYAUTO
<br />L(F.aacs,40N _
<br />I `I BCOILV INJURY (Po[pe sons $
<br />INSURER 8:'
<br />INFINITY TIMING
<br />INSURER c:
<br />229 SOUTH OLIVE AVE
<br />RIALTO, CA 92376
<br />INSURER o:
<br />CQj i,I EAGH OCCURRENCE
<br />(
<br />INSURER E ; I
<br />�S
<br />� I AGGREGATE 1,
<br />INSURER F:
<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 />uDl.MO MOYEFF Po"LO X i -- -
<br />LTR I TYPE DPINSURANCE , I � P041GY NUMBER � ' IMMIOOIYYYyI I (MMldpIYYVYI' LIMITS
<br />A'COMMERCIAL GENERALLIABILITY !
<br />jEACH OCCURRENCE S1,000,000
<br />t CLAIMS -MAGE ROCCUR '/\I
<br />HED 10015218 01(2712016I01/27j2017'pREMISESIEaoccuanow 15100,000
<br />_
<br />:MED EXP IA&I and Retinal S 5,000
<br />_
<br />PERSONAL B ADV INJURY`=31,000,000
<br />I
<br />GENL AGOREOATE UNI APPLIES PER
<br />;GENERAL AGGREGATE :52,000,000
<br />-----'E—
<br />L_IJIPOLIGY PRO- !
<br />_EQT _J LOC
<br />PRODUCTS.GOMPOPAGGi41rOOO,DDD
<br />i I
<br />l OTHER:
<br />S
<br />.'
<br />AUTOMOBILE LIABILITY -.
<br />! { ,COMB NEO SINGLE V-0 S
<br />ANYAUTO
<br />L(F.aacs,40N _
<br />I `I BCOILV INJURY (Po[pe sons $
<br />ALLO'WNE6
<br />AUTOS 1 AUTOS SCHEDULED
<br />- I -
<br />8001LY INJURY Par br=and's
<br />NON,WNEO
<br />l HIRED AUTOS AUTOS
<br />I PROPERTY AMAGE 1 S
<br />- 6`IA �(PeracddaD1_ S
<br />UMBRELLA LIAB
<br />L—, OCCUR -
<br />l
<br />CQj i,I EAGH OCCURRENCE
<br />(
<br />j EXCESS LIAB CLAIMS.MADE� i
<br />�S
<br />� I AGGREGATE 1,
<br />I'. DEO I RETENTIONS
<br />G�
<br />I WORKERS COMPENSATION
<br />,AND EMP40YER3'LIABILITY YIN, ! f
<br />I�' PER OTN.
<br />+� ISTATUTE IER
<br />- ANY PROPRIETOR/PARTMEER/EXECUTIVE -""-
<br />OFFICERIMEMSER EXCLUDED' NIA
<br />IMandatN i, In
<br />NH)
<br />"sense
<br />��``'�, �'('t
<br />CR EACH ACCIDENT S
<br />and
<br />DECdRIPTION
<br />.D—ISE-A—SE Ed .. .._,..,___... _. _.
<br />OFOPERATIONS below
<br />E L DISEASE - POLICY LIMIT :, 5
<br />I
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101. Additional Remarks Schedule, maybe aUs.hed H mor. apace la hquimd)
<br />CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED:
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES, AND VOLUNTEERS
<br />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CALIFORNIA 92701
<br />THE CITY OF SANTA ANA, ITS
<br />EMPLOYEES, AND VOLUNTEERS
<br />20 CIVIC CENTER P'LAZ
<br />SANTA ANA, CALIFORNIA 92701
<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 />2ESENTATIVE
<br />© 1988.2014 ACORD CORPORATION
<br />All sense maorvoH
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />Produced using Forms Ross Plus software www PormsBnab cone I,pass.,ws Puolsnmg BOO20B1977
<br />
|