HomeMy WebLinkAbout- - A.C.T. GIS Support Att. 4 - 7/6/2010ACORD. CERTIFICATE OF LIABILITY INSURANCE
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PRODUCER
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
DD
Joanne Bryant, Agent
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
AINSURERS
2579 San Ramon Valley Blvd. Ste. A201
San Ramon, CA 94583
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AFFORDING COVERAGE NAIC #
INSURED
ACT GIS Incorporated & Kyler Diershaw
19000 Grovewood Drive
INSURERA: State Fann General Insurance Company 25151 25151
INSURER B: State Farm Mutual Automobile Insurance Company 25178 25178
08/31/10
EACH OCCURRENCE $ 1,000,000.00
Corona, CA 92881
INSURER C:
X COMMERCIAL GENERAL LIABILITY
INSURER D'
INSURER E:
COVERAGES
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 AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
DD
TYPEOF1
POLICY NUMBER
POLICYEFFECTIVE
DATE w
POLICYEXPIATION
ATE M DD
LIMITSry
A
X
GENERAL LIABILITY
97.BJK11-62
08/31/09
08/31/10
EACH OCCURRENCE $ 1,000,000.00
DAMAGE TO PREMISES EaoccuDnce $ 300,000.00
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE F�I OCCUR
MED EXP (My one person) $ 5,000.00
PERSONAL B ADV INJURY $ 1,000,000.00
GENERALAGGREGATE $ 2,000,000.00
GEWL AGGREGATE
LIMIT APPLIES PER:
PRODUCTS-COMP/OPAGG $ 2,000,000.00
X POLICY
PRO- OC
IECT
B
X
AUTOMOSILEUMILTTY
053719C-93
08/31/09
08/31/10
COMBINED SINGLE LIMIT
$ 1,000,000.00
ANY AUTO
053719C-94
(Ea accident)
X
ALL OWNED AUTOS
BODILY INJURY
$
SCHEDULEDAUTOS
(Per person)
BODILY INJURY $
HIRED AUTOS
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per.cadent)
GARAGEUABILTTY
AUTO ONLY -EA ACCIDENT $
OTHERTHAN EAACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMS MADE
AGGREGATE $
$
DEDUCTIBLE
RETENTION $
TATU$
WCSUMIT OTH-
W DRIERS COMPENSATION AND
EL EACH ACCIDENT $
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECIITIVE
ELDISEASE-EAEMPLOYEE $
OFFICER/MEMBER EXCLUDED?
N yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS
Adding the city of Costa Mesa its officials, officers, employees, and volunteers as additional insureds an additional
insured as respects general liability. Insurance is primary and non-contributory. 10 days notice of cancelation for
non-payment of premium.
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92628
ACORD 25 (2001108)
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MNL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDERI ZNAMED O�/$IE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBU ION Q LU�II4Y OF ANJ jUPI]N THrm INSURER ITS AgI(WS OR