|
AC RO® CERTIFICATE OF LIABILITY INSURANCE
<br />DA6 (MMIDD 6 )
<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(les) 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 />CONTACT Mar Amiri
<br />NAME: y
<br />James G Parker Insurance Associates
<br />PHONE
<br />Ezt1, (661)284-1708 FAXINCNOP 1559)222-1721
<br />License #0554959
<br />ADryDREBS:mamiri@jgparker. court
<br />P 0 Box 3947
<br />INSURERS AFFORDING COVERAGE T—
<br />INSURER ANavi ators Insurance Company_.,___,_
<br />42307
<br />Fresno CA 93650
<br />INSURED
<br />_
<br />INSURER B:HDI-Gerlinc America Ins Cc
<br />141343.
<br />INSURER CdCYPreSS Insurance Company
<br />'10855
<br />Midori Gardens Inc
<br />INSURERD:
<br />Midori Landscape Inc
<br />INSURER E:
<br />3231 Main Street
<br />INSURER F:
<br />Santa Ana CA 92707
<br />COVERAC;FS CFRTIFIr.ATFNIIMRFR0.6-17 GL.autc.excess & WC RPVICIf1N Nil HVIRP17.
<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
<br />CONTRACT OR OTHER DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR' TYPE OF INSURANCE
<br />ADDL.SUBRI
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MMIOOIYYYY -(MMIDOIYYYY' LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />- EACH OCCURRENCE $
<br />1,)00,000
<br />A CLAIMS I OCCUR
<br />DAMAGE T R ED
<br />100, 000
<br />-MADE X
<br />PREMISES Ea occurrence $
<br />i LAs12901077
<br />! 5/l/2016
<br />6/1/2017 MED EXP(Any one person) $
<br />5,000
<br />—�
<br />PERSONAL &ADV INJURY I$
<br />1,000,000
<br />I.EN'L AGGREGATE LIMIT APPLIES PER: 'Ii
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />PRO1
<br />POLICY LXj JEC LOC
<br />III PRODUCTS - COMP/OP AGO $
<br />2,000,000
<br />— ---
<br />'. OTHER: $1, 000 deductible 1
<br />$
<br />'AUTOMOBILELIABILITY
<br />_
<br />'., COMBINED BINGLE LIMIT I$
<br />(Ea accident)
<br />1,000,000
<br />B ', X ANY AUTO
<br />III
<br />I BODILY INJURY (Per person) $
<br />_i ALL OWNED SCHEDULED
<br />JIAUTOS AUTOS GA2OX000377010OCA
<br />6/1/2016 6/1/2017 BODILY INJURY (Per accident) $
<br />-
<br />X :HIRED I. X' 1,
<br />PROPERTY DAMAGE
<br />AUTOS AUTOS
<br />(Per accident) _._
<br />Uninsured motorist combined $
<br />1,000,000
<br />(UMBRELLA LIAB X FOLLOWING FORM
<br />OCCUR I
<br />I EACH OCCURRENCE
<br />__.__..
<br />$
<br />5,000,000
<br />$
<br />_..____
<br />5,000,000
<br />A %'. EXCESS LIAB _ CLAIMS -MADE '
<br />AGGREGATE
<br />$
<br />DED 1 D I RETENTION$ NONS SF16EXC785300IV 6/1/2016 6/1/2017
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />__�
<br />$
<br />1,000,000
<br />'.ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT_
<br />NIA,
<br />OFFICERIMEMBER EXCLUDED? �.
<br />C iMandatory In NH) MIWC708663 ''.
<br />JJ
<br />6/1/2016 6/1/2017 E.L. DISEASE -EA EMPLOYEq$
<br />1,000,000
<br />If yes, describe under
<br />-0ESCRIPTI )N OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />($
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may
<br />be attached If more space Is required)
<br />Job: City of Santa Ana
<br />The City of Santa Ana, its officers, agents and employees
<br />are included as addition la,,,�$rsureds
<br />as per
<br />attached endorsement #AGCG2010BPN 0704.
<br />1�y ��
<br />(714)571-4211 scuevas@santa-ana.org
<br />City of Santa Ana
<br />Parks, Recreation 6 Community
<br />Services Agency
<br />Attn: Silvia Cuevas
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DgS"99b"POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />S Parker III/MARY
<br />All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025i?r i
<br />
|