|
SBACO-1 OF ID: RJH
<br />_OFtfJ CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />�'
<br />03/13/2016
<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
<br />CONTACT Clem J Wandrisco, III
<br />Henderson Brothers, Inc.
<br />920 Ft Duquesne Blvd
<br />------ ---- ----- ----- -----
<br />L�NNs aKq:412-261.1842 ._,... FAX ,g0( 412-261-4149 _
<br />Pittsburgh, PA 15222
<br />Clem J. Wandrisco, III
<br />aooeess. cfwandrisco@hendersonbrothers com
<br />-___ . ___.. _.._ _.._. .....__
<br />IN$URER(S)AFFORDINGCOVERAGE
<br />_.____
<br />NAIC#
<br />EACH OCCURRENCE 900,00_0
<br />A oENTED
<br />`9001000PREMISEB
<br />___..__
<br />INSURER A: Travelers Property& Casualty
<br />25674
<br />INsuaED SBA Communications Corporation
<br />_
<br />INSURER 8: The Charter Oak Fire Ins. Co.
<br />.25615
<br />8051 Congress Ave.
<br />Boca Raton, FL 33487
<br />-- -- — "
<br />INSURER C:St Paul Fire & _Marine Ins Co _
<br />24767_. _
<br />INSURERD:Illinois Union Insura_n_ce Compa
<br />27.960
<br />Ir
<br />$100,000 SIR
<br />INSURER E :
<br />INSURER F:
<br />MED EXP (Any ane persen) $ N/
<br />PERSONAL&ADVINJURY $ 900,000
<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 RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INTR
<br />I TYPE OF INSURANCE
<br />IN Di
<br />iIW D
<br />POLICY NUMBER
<br />MMIDD[Y Y
<br />MM)DDY�
<br />�_.__ _
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL
<br />COMIGENERALLIABILITY
<br />EACH OCCURRENCE 900,00_0
<br />A oENTED
<br />`9001000PREMISEB
<br />-X
<br />CLAMS-MADErXOCCUR
<br />X
<br />TJEXGL474M8138TIL16
<br />03/15/2016I
<br />03/15/2017
<br />I�$
<br />(Ed 0ccuyronee) $
<br />$100,000 SIR
<br />MED EXP (Any ane persen) $ N/
<br />PERSONAL&ADVINJURY $ 900,000
<br />AGGRE�GATE LI APPLIES PER:
<br />'GEN'L
<br />!
<br />j
<br />I GENERAL AGGREGATE $ 2,000,000
<br />POLICY L` JELOC
<br />PRODUCTS - COMP/OP AGG ! $ 2,000,000
<br />T
<br />$
<br />OTHER'
<br />1
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Eea cident $ 1,000,000
<br />A
<br />ANY AUTO
<br />TC2JCAP474M814AT1L16
<br />03/15/2016
<br />03/15/2017
<br />_
<br />BODILY INJURY (Per person) $
<br />PX
<br />ALL OWNED �SCHEDULED AUTOS AUTOSBODILY
<br />HIRED A X NON -OWNED
<br />I
<br />k
<br />INJURY(Per accident)rAl,TOS
<br />GE + -
<br />PeOraccid
<br />X
<br />SI
<br />i
<br />nOA _
<br />1$
<br />I
<br />100,000
<br />$
<br />X
<br />UMBRELLAUAa i X
<br />OCCUR
<br />I
<br />EACH OCCURRENCE $ 25,000,000
<br />C
<br />! EXCESS UAe
<br />I CLAIMS_MAOE1
<br />IZUP15N3740516NF
<br />03115/2016
<br />1 0311 512017
<br />AGGREGATE $ 25,000,000
<br />._.__ _..__.
<br />I
<br />D o 10,000;
<br />RETENTIONS
<br />$
<br />WORKERS COMPENSATION
<br />iAND EMPLOYERS' LIABILITY
<br />- ERLI Thl-
<br />X STATUTE :ER I_
<br />B
<br />'JANYPROPRIETORIPARTNEREXECUTIVE Y�IN'"I
<br />AOS
<br />( )
<br />031151201610311512017
<br />1
<br />_-.
<br />E.L. EACH ACCIDENT is 1,000,000
<br />A
<br />OFFICER/MEMSER EXCLUDED? I_JUN1A
<br />(Mandamryln NH)
<br />i
<br />ITC20UB475M437816
<br />1RJUB475M438A16
<br />03/15/2016
<br />03/1512017
<br />E.L. DISEASE - EA EMPLOYEE 1,000,00_0
<br />II`/es, tlescAbs under
<br />DESCRIPTIONOFOPERATIONSbelow
<br />i
<br />I
<br />(
<br />!
<br />_
<br />— - -
<br />E.L. DISEASE -POLICY LIMIT$ 1,000,000
<br />D
<br />PROFESSIONAL
<br />COOG24541800006
<br />03/15/2016
<br />i 03/15/2017
<br />CLAIWAGG 51000,000
<br />!POLLUTION
<br />:
<br />I
<br />MSIR 100,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be anached If more space Is required)
<br />Site Number: CA45888-A-0, Site Name: Windsor Park,
<br />Site Address: 2915 W LA Verne Ave., Santa Ana, CA
<br />UCKIII-II.A It NULUtK L.ANL:tLLA I ILJN ••" "+'"+'
<br />CA45888
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Crit Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City
<br />Attn: PRCSA ACCORDANCE WITH THE POLICY PROVISIONS.
<br />26 Civic Center Plaza, M-75
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
|