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HomeMy WebLinkAboutInsuranceAW o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/17/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION is WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER AHERN INSURANCE BROKERAGE 9655 GRANITE RIDGE DR STE 500 SAN DIEGO, CA 92123 (888) 661-3938 X0052 882 CONTACT NAME: PHONE A/C, No, Ext): (888) 661-3938 FX (AAA, No): (877) 5526091 E-MAIL ADDRESS: Service.center@travelers.com PRODUCER CUSTOMER ID #• 1104EA146 INSURER(S) AFFORDING COVERAGE NAIC # INSURED PROJECT PROFESSIONAL CORP 656 FIFTH AVENUE STE. W SAN DIEGO, CA 92101 INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURER B:TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA INSURER C: INSURERD: INSURER E: INSURER F: COVERAGES ERTIFICATE NUMBER: 6 • THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B GENERAL X LIABIITY COMMERCIAL GENERAL LIABILITY X OCCUR X 680-9688P418-11 05/10/2011 05/10/2012 EACH OCCURRENCE $2,000,000 DAMAGE TO ERENTED PREMISESoccurrence) $300,000 CLAIMS -MADE MED EXP (Any one person) $5,000 X HIRED AUTO PERSONAL 8, ADV INJURY $2,000,000 X NDN OWNED AUTO GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- 7 POLICY X JECT ILOC PRODUCTS - COMP/OP AGG $4,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY acci nt)AMAGE $ $ $ U UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ D DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE I OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below N/A UB-1329R331-11 05/10/2011 05/10/2012 X 1 TORY LIMITS OER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) AS RESPECTS TO GENERAL LIABILITY, CERTIFICATE HOLDER IS ADDITIONAL INSURED - DESIGNATED PERSON/ORGANIZATION, CG T4 91 . CERTIFICATE HOLDER CANCELLATION CITY OF NATIONAL CITY, ITS ELECTED OFFICIALS, OFFICERS, AGENTS, 1243 NATIONAL CITY BLVD NATIONAL CITY, CA 91950 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (,/` 51 © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD TRAVELERS J One Tower Square, Hartford, Connecticut 06183 CHANGE ENDORSEMENT INSURING COMPANY: TRAVELERS CASUALTY INSURANCE COMPANY OF AMERICA Named Insured: PROJECT PROFESSIONAL CORP Policy Number: I-680-9688P418-ACJ-11 Policy Effective Date: 05-10-11 Policy Expiration Date: 05-10-12 Issue Date: 08-16-11 Premium $ NIL Effective from 05-10-11 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: TRANSACTION EFFECTIVE DATE IS AMENDED TO 08/11/2011 ADDITIONAL INSUREDS ARE ADDED TO THE POLICY AS PROVIDED UNDER THE ATTACHED ENDORSEMENT(S): CG T4 91 THE FOLLOWING FORMS AND/OR ENDORSEMENTS IS/ARE INCLUDED WITH THIS CHANGE. THESE FORMS ARE ADDED TO THE POLICY OR REPLACE FORMS ALREADY EXISTING ON THE POLICY: CG T4 91 11 88 NAME AND ADDRESS OF AGENT OR BROKER Countersigned by AHERN INSURANCE BRKRG X0052 9655 GRANITE RIDGE DR STE 500 SAN DIEGO CA 92123 DATE: Authorized Representative IL TO 07 09 87 (Page 01 of 01) Office: ELMIRA NY SRV CTR POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: I-680-9688P418-ACJ-11 05-10-11 08-16-11 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL TO 07 09 87 CHANGE ENDORSEMENT IL T8 01 01 01 FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS COMMERCIAL GENERAL LIABILITY CG T4 91 11 88 ADDL INSD-DESIGNATED PERSON/ORGANIZATION IL T8 01 01 01 PAGE: 1 OF 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: I-680-9688P418-ACJ-11 ISSUE DATE: 08-16-11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of person or organization: CITY OF NATIONAL CITY, ITS ELECTED OFFICIALS, OFFICERS, AGENTS, AND EMPLOYEES 1243 NATIONAL CITY BLVD NATIONAL CITY CA 91950-4301 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 acts or omissions. CG T4 91 11 88 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 TRAVELERS JO. ONE TOWER SQUARE iiAR1FGRD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 04 03 06 (01) — 001 POLICY NUMBER: (IJUB-1329R33-1-11) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 1.000 % OF THE CALIFORNIA WORKERS' COMPENSATION PREMIUM OTHERWISE DUE ON SUCH REMUNERATION. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION CITY OF NATIONAL CITY CONSULTING DATE OF ISSUE: 03-31-11 STASSIGN: