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JLEEENG-01 YUENG <br />`�� CERTIFICATE OF LIABILITY INSURANCE <br />DAT/16/D0IVYYV) <br />8116/2016 <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(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 License # OE67766 <br />IDA Insurance Services <br />3875 Hopyard Road <br />Suite 240 <br />CONTACT Gigi Yuen <br />PHONE FAX <br />AIC No Ex : (925) 416-7862 Arc No : 925 416-7869 <br />E-MAIL Gi I.Yuen@l1ioausa.com <br />ADDRESS: 9 i.Yuen@ioausa.com <br />CA 94588 <br />INSURER(S) AFFORDING COVERAGE <br />NAICq <br />INSURER A:Travelers Property Casualty Company of America <br />25674 <br />INSURED <br />INSURER B:Argonaut Insurance Company <br />19801 <br />INSURER C: <br />JLee Engineering, Inc. <br />INSURER D <br />430 S. Garfield Avenue, #301 <br />Alhambra, CA 91801 <br />INSURER E: <br />ES <br />PREMISEaoc urr nce $ <br />INSURER F: <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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />Imp <br />Mat <br />POLICY NUMBER <br />POLICY EFF <br />Irl <br />POLICY EXP <br />MMIODII'YYY LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 2,000,00 <br />CLAIMS FRIOCCUR <br />6808855N594 <br />09/01/2016 <br />09101/2017 1+000,00 <br />-MADE <br />ES <br />PREMISEaoc urr nce $ <br />MED EXP (Any one person) $ 10,000 <br />PERSONAL &ADV INJURY $ 2,000,00 <br />AGGREGATE LIMIT APPLI ES PER: <br />GENT <br />GENERALAGGREGATE $ 4,000,00 <br />POLICY ® JEST 1:1 LOC <br />PRODUCTS COMP/OPAGG $ 4,000,00 <br />OTHER: <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 2,000,00 <br />Ea accident <br />A <br />ANYAUTO <br />6808855N594 <br />09/01/2016 <br />0910112017 BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />- <br />tid <br />Per accident) <br />BODILY INJURY ( ) $ <br />X <br />X NON -OWNED <br />PROPERTY DAMAGE $ <br />HIRED AUTOS AUTOS <br />Per accident <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />AGGREGATE $ <br />DED RETENTION$ <br />1 <br />1 $ <br />WORKERS COMPENSATION <br />X PER 10TH - <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER <br />A <br />ANY PROPRIETORIPARTNEWEXECUTIVE <br />UB329OT632 <br />09/01/2016 <br />09101/2017 E.L. EACH ACCIDENT $ 1,000,00 <br />OFFICERIMEMBER EXCLUDED? F-1 <br />(Mandatory in NH) <br />NIA <br />E.L, DISEASE -EAEMPLOYEd $ 1,000,00 <br />If yes, describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,00 <br />B <br />Professional Liab. <br />IAE1252604 <br />09101/2016 <br />09/01/2017 Per Claim 1,000,00 <br />B <br />Professional Liab. <br />IAE1252604 <br />09/01/2016 <br />0910112017 Aggregate 1,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />All Operations of the Named Insured. <br />General Liability: See Additional Insured Endorsement attached; such coverage is Primary & 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 aformentioned 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 />�d a s �/ <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 />City of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />Planning and Building Agency <br />20 Civic Center Plaza, M-20 <br />n -. <br />Santa Ana CA 92702 <br />:-'-'-'' ----- <br />ACORD 25 (2014/01) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />