HomeMy WebLinkAboutORANGE COUNTY BAR FOUNDATION 5
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ACORCT
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Dale (mmJddlyy)
Produc r
Mary Jane Ricard
4/12/2005
THIS CERTifiCATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
C & P Insurance Services
3580 Pacific Coast Highway Suite 3
Long Beach
562-986-4251
www.insurancelink.com
0556464
INSURER
UR R
Maryland Casualty Company
CA
90804
A
A ,)[('1 ~Cr:I- 3/
INSURER
B
United States Liabilty Ins. Company
Insured
Orange County Bar Foundation
313 N. Birch Street
2nd Floor
Santa Ana
INSURER
C
CA 92701
INSURER
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY POLICY
EFFECTIVE EXPIRATION
DATE DATE
DO DO
NSR
LTR
TYPE OF INSURANCE
POLICY NUMBER
liMITS
GENERAL LIABILITY
COMMERCIAL GENERAl. UAB PPS 34632555
~f' CLAIMS MADE [lIOCCUR
3/15/2005
EACH OCCURRENCE $
3/15/2006 fiRE DAMAGE (An 1 fire) $
MED EXP (A one et"soo) $
PERSONAL & AOV INJURY $
GENERAL AGGREGATE $
PROOUCT5-COMP/OP AGG $
$
3/15/2006 COMBINED SINGLE LIMIT $ 1,000,00
BODILY INJURY
(Per person) $
BODilY INJURY
{Per accident) $
3/15/2005
PPS 34632555
PPS 34632555
PROPERTY DAMAGE
{Peraccjdent}
DEDUCTIBLE
RETENTION S
WORKERS' COMPENSATION &
EMPLOYERS' LIABILITY
$
AUTO ONLY. EA ACCIDENT S
OTHER THAN EA ACe S
AUTO ONLY; AGG S
EACH OCCURRENCE $
AGGREGATE $
$
$
$
APPROVE AS TO ORM
SSIS an y
STATUTORY LIMIT THE
El EACH ACCIDENT $
EL DISEASE. EA EMPLOYEE $
El DISEASE. POLICY LIMIT $
Per Occ 1,000,000
Aggregate 1,000,000
Deductible $1,000
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Directors & Officers
Liability
ND 0121018 5/1/2004 5/1/2005
Certificate Holder is an additional insured per attached endorsement CG 20 26 11 85.
The insurance provided by this endorsement is primary insurance and is not additional to or
contributing with any other insurance carried by or for the benefit of the additional insureds.
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILl~)(;:(;() MAIL
~DAYS WRITTEN NOTICE TO THLCERTIFICATE HOLDER NAMED TO THE
LEFT, :QQX~
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AUTHORIZED
REPRESENTATIVE
The City of Santa Ana
Santa Ana Community Development
Agency
Attention: Carla Thompkins
P.O. Box 1988
Santa Ana CA
* 10 Da s for Non-Pa ment of Premium
92702
ACORD 25-S (7/~7)
Jim Mulligan
,.... ..
cre:ated -at www_~e tertsONpNE~com
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@ ACORD CORPQRAT(O/il198'a:
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POLICY NUMBER PPS 34632555
Orange COllnty Bar Foundation
313 N. Birch Street
COMMERCIAL GENERAL LIABILITY
CG20261185
4/12/2005
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided und.er the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
The City of Santa Ana
Santa Ana Community Development
Agency
Attention: Carla Thompkins
P.O. Box 1988
Santa Ana
CA 92702
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the
Schedule as an insured but only with respect to liability arising out of your operations or premises owned by
or rented to you.
APPROVED AS TO FORM
Y3~f1;,J.!'z
'Laura Stitt eedy
Assistant City Attorney
CG20261185