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Home My WebLink AboutMINOR MOD CERT OF LIABILITY INS 11-16-18,..mwr. IDECO-1 OP ID: T9 7 ''°mow CERTIFICATE OF LIABILITY INSURANCE �,,,,�,,,r,..•- DATE (MMIDDNYYY) 01118/2018 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 Brakke- Schafnitz Ins. Brokers License #OK07568 28202 Cabot Road, Suite 600 Laguna Niguel, CA 92677 -1251 Alice McLaughlin NAME: Tanya Vogt ONE PHONE 949- 365 -5176 AIC No : 949- 313 -3293 No Ext : E -MAIL ADDRESS: tanya.vogt @sig.us INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Everest Indemnity Ins. Co. EF4ML05450 -171 BAA57032673 10/18/2017 12/06/2017 INSURED (DECO, Inc. 431 W Blueridge Ave Orange, CA 92865 -4203 INSURERS. American Fire and Casualty Co. 24066 INSURER C: Preferred Employers Ins. Co. 10900 MED EXP (Any one person) $ 5,000 INSURER D: INSURER E: PERSONAL & ADV INJURY $ 1,000,00 INSURER F: AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON OWNED HIRED AUTOS X AUTOS GENERAL AGGREGATE ......�.,. �+.-�+ *+C0T1C1f%ATC k11 1000:0w KCVISICJN NLIMt$tK: 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. ILTR TYPE OF INSURANCE DD B POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FRI OCCUR P.O. BOX 26000 AUTHORIZED REPRESENTATIVE EF4ML05450 -171 BAA57032673 10/18/2017 12/06/2017 10/1812018 12/06/2018 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RLN I ED PREMISES Ea occurrence $ 50,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON OWNED HIRED AUTOS X AUTOS GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG $ 2,000,00 COMBINED SINGLE LIMIT Ea accident $ $ 1,000,00 AUTOMOBILE X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X A C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N/A EF4C000735 -171 WKN157673 -4 1011812017 02/05/2018 10/18/2018 02105/2019 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,00 DED I X RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below X STATUTE ER" $ E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A A Pollution Liab Professional Liab EF4ML05450 -171 EF4ML05450 -171 10/18/2017 10/18/2017 10/18/2018 10/18/2018 EachClairn 1,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) License #744619 rlAmr_F1 1 nT1nm IrCK 111-It.A 1 C nVLUr =rt - - -- - - CONTRAG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractors State License ACCORDANCE WITH THE POLICY PROVISIONS. Board P.O. BOX 26000 AUTHORIZED REPRESENTATIVE Sacramento, CA.95826 AA T ■AG■ . ■■ _ _L_,._ V 7y252f -LU"14 HI+VKU �.VRrV1w11v1v. r�u ��ynia �cac�vcu. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD