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SUPER ANTOJITOS (3) - 2017
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SUPER ANTOJITOS (3) - 2017
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Last modified
6/15/2022 3:21:48 PM
Creation date
11/6/2017 9:05:15 AM
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Contracts
Company Name
SUPER ANTOJITOS
Contract #
N-2017-229
Agency
Parks, Recreation, & Community Services
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./'7 CCOR,0 DATE,(MM/DD/YYYN) <br />!�..-•' CERTIFICATE OF LIABILITY INSURANCE11102/2017 <br />-- TI <br />THIS GERTIFIGATE IS LfiSLLEDASRMATTBR pF:-tNFSJRMA'CLON.ONb15AMD,GDNEER6,WP=RtGHT$:URPNTIAESkERTIPIGATE;HOLDER.;THI$:CfftTIFIG/nTE DDES'NDTAFFIRMATIVELY DRi'NRGATIkELY <br />.AMEAI➢,EXT,E-N :ORAVTERTIRE CAVERAG%RPFORDB98Y THilA91iDIE&'BBLQW,THIS.CERTMICATE OFiINSURANCEIDDES NOT+CONSYITOTE A CONT.RAC'rBBTW.HBNTHEIS$UINGTNSURER(&). <br />;AUTHORIZEDREPRE8ENTATIVESORPRODUCER,AND+THE•CERTIEICA'Me lOLD%R. <br />tIMR,ORTANtT:+.IfShenartlFlcate4lpldar IeanAPPITIEINA4.IN811REA.dhelppllayjfe5)muaYhaveADDITIONALYINSURED proviplonpnr 6e endarsad.lf$U9RD.GATtON tS WAIVED,,Wbjecttn,Ihe:termsand <br />+e9MIt190b of`theA statemenCon thisvaftlficate;dflp9 notconia"ighwo the contif make holderip.lieu 'afqucb erldamemeR((s). <br />PRODUCER :CONTACTWiEa_.. _...._....... _. <br />dyfti / 9�r), /7 _ 92 NAME: Wend Iy MLIGOZ _.... <br />PAY <br />.2441N-TwxtG `) A Ave Ste EP V� / s (�" (HDNNp EXT)714+550-11 DO f !C,f10)' 714,550-717.0 ..... <br />E-MAIL <br />_Santa Arta CA W70548E1 ADDRESS WRIU11.04farmef83gent,com <br />IN$URER(9)ARPORDFNG:GAVERAGE NAIG# <br />INSURED TNSURERA Tfwak?1geUfaRCe.EXDh>agge 21709 <br />INSURERO Faf nerS InBUranoo Exchange _ 21052 <br />#EU7A9„PE, #�UILLERML) -- - -.__ __. <br />INSURERC MId:OogtUry InBLrance ("ornpony 21687 <br />fl®A'S�iUP6R�.NT.t�JISY115;E�YIRk2E$_�u — <br />1702 �N;BRISTQVST I NaWRERD STEAD _..._ <br />SANTA ANA .CA 92706 INSURERS:...- <br />.............. _.... _ . _ ....................... . <br />IN$41RER_F: <br />.COVERAGES GERTIFIGATE`NUMBkR: ieEVISION:NUNI%ER: <br />Tkl(S115 TppER@IPY TPWT'1'Hk'POL{CIEs OF IN$WRANGE LISTBp BEEOWHAVE BEEN IRSURp TOTWE INSURED NAMEA90YERORVHE POLICY RERIDD INDICAIIED;NOTWITHSTANDING ANY <br />$kQUIREMENiLtfERM QRSQMDdP[DRA4F'ANY,CQNS{(ACT!Qfr'(dFiFtORIpflCA1M@NP W4'6INiRESGECTTOeWHICH.l1H13CERITIF1CATE MAY BE IS5UED: QR MAY PERTAIN, THE IYSURANGE`APPORUED DYTHE <br />POLICIES OF SUGPI POLICIES UMplS£H¢WNMWHAVEAftEN REDUCED,BYPAIDOLNIMS, <br />TBR TIMPEOFINSURANCE AINSPL VIVOP.OUCY NUMBER RGLICYEPF POLICY EXP MY3S <br />(MM/DD/:YYYY) (MMIND)YXYHi) <br />EACH <br />`X CQMMERCIALGENERALk1A%IGfPY EACH:OCGURRBNCE $ 1;000;0.00 <br />C1.AIMS;MAQE X OCCUR DAMAGE TOREaNTBD <br />PREMISES(Ea DawreRve) $ 2$D;00➢ <br />A Y IN Q05415467 <br />4BNR.AGGREGAI'E LIM4b-APRUIES.PER: <br />X IPOWCY ;PROJECT LOC <br />OTHER: <br />AUTONE0816ELIABILLWY <br />rMEDEXR(Anyonepersoo) s 5;DO0 <br />11101/2017 1'I70;1/2O1B .PERSONAL&AITV:INJURY $ 1 gpDlppp <br />._... ANYAUTO <br />rOWN&DAUTOS 'SCHEDUHID <br />ONLY AUTOS <br />'HIRED AUTOS INON,QWNRD 6 " "p <br />ONLY AUTOSMNLN <br />4y <br />.UMPRO LIAR OCCUR ... ......... ___-..__ .,,y / �. <br />EXCE'SSLiAB CIAIMS114Af7E <br />DED RETENnOn$ <br />WORKERS.CDMPENSAMON __._.... <br />ANY PROPRIETORY PARTNI <br />BXE4U2'IR ,(MandaWryi REH <br />-11y7D.WR®©F eugjty GfSCRJ HS <br />OPE TIONSbalow rlilEStRI%IlQN;pF <br />rOPERATIONS:bafpw <br />xfN <br />N/A <br />GENERAL AGGREOAIiE_ $ 2,0Op rlpo <br />IRRODUCTS COMP/OPAGG $ 2,000„000 <br />COMBINEDSINGLE LIMIT _B <br />(EaecLiflw@) <br />,0DIEVIINjURYRPw,Penm) '$ <br />BODICV INIURY(Paraer,I:denG)� <br />PROREWY DAMAGE <br />(Perecndent) <br />$ <br />EACNIOCCWRRENGE $ <br />AOPR£CrvATk $ <br />8 <br />PER OTHER <br />S:FATUTE <br />6L.EAGHACCID'BNIT $ <br />EiL OPSEASE EAEMPLQYEE $ <br />RIL 01IPOLOYIL'IMIT <br />: DESCRI.BRI$ ICLS , A NTAGANA,CV927{'EE(AGGRO LDI tAdtllYipndlRartretksSChedule,+>may beaHaahadR:mprasRaca lssapUiFed% <br />SI,702 N'&RtSTiSOL ST mTANTA ANA CA�82708 <br />CBRTIPICATE;NIpUDER .CANCELLATION _ <br />THELOITYOFSAN,TAANA <br />SHOULD ANY PTTN PfCZfDATE THEREOF, NTpHTE'CEEBOWV1£LDDaEESDELIVERED :(INCAIEGSCBOEBG➢AAPICE'WITH THEAEDTLHICEYB'XRRRAIRYAIT$ItAONNS <br />zo clutQ rt:ENmEre PLAZA k1�3rE�TI}��ESENTATJVE <br />SANTAANA :CA ,927D1_. _.... _. _.. <br />AC0RD25 (2015/03) algW2015 ACORDCO:RPORATON.. AII.RightsReserved <br />31 1769 11-15 The ACORD nome;andlogo are;reg�isReredvarks DfAMIRD <br />
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