1001486 132849.14 04-13-2022
INSR
LTR TYPE OF INSURANCE ADD
INSD
SUB
WVD POLICY NUMBER POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT
LOC
OTHER:
EACH OCCURRENCE $
DAMAGE TO RENTED
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
$
AUTOMOBILE LIABILITY
ANY AUTO
OWNED
AUTOS ONLY
SCHEDULED
AUTOS
HIRED
AUTOS ONLY
NON-OWNED
AUTOS ONLY
COMBINED SINGLE LIMIT
(Ea accident) $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident) $
$
UMBRELLA LIAB OCCUR
EXCESS LIAB CLAIMS-MADE
DED RETENTION $
EACH OCCURRENCE $
AGGREGATE $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
Y / N
N / A
PER
STATUTE
OTH-
ER $
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE - POLICY LIMIT $
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
CANCELLATION
E-MAIL
ADDRESS:
CONTACT
NAME:
PHONE
(A/C, No, Ext):
FAX
(A/C, No):
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
PRODUCER
INSURED
REVISION NUMBER: CERTIFICATE NUMBER: COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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).
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.
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.
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
AUTHORIZED REPRESENTATIVE
Y Y Y
642 2191-B01-75B 08/01/2023 08/01/2024 1,000,000
1,000,000
1,000,000
[email protected]
Marisela Marin
310-330-8220
State Farm General Insurance Company 25151
FLORENCE HARRISON
227 S LA BREA AVE
INGLEWOOD, CA 90301
ALL CITY MANAGMENT SERVICES, INC.
10441 PIONEER BLVD, STE 5
SANTA FE SPRINGS, CA 90670
01/29/2024
City of Huntington Beach
2000 Main St
Huntington Beach, CA 92648 Completed by an authorized State Farm representative. If signature is required, please contact a State Farm agent.
POLICY NUMBER: 642 2191-B01-75B COMMERCIAL AUTO LIABILITY CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTO LIABILITY
NONOWNED AUTO LIABILITY
SCHEDULE
A. Section II – Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for
the additional insured(s) at the location(s) design ated above. Additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or "property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1
Name Of Additional Insured Person(s) Or
Organization(s): Location(s) Of Covered Operations
City of Huntington Beach, its officers,
elected or appointed officials, employees,
agents, and volunteers.
ONGOING OPERATIONS
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Policy Number: 642 2191-B01-75B COMMERCIAL AUTO LIABILITY CA 04 44 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
Business Automobile
NONOWNED AUTO
Named Insured: ALL CITY
MANAGEMENT SERVICES
Endorsement Effective Date:
08-01-2023
SCHEDULE
Name(s) Of Person(s) Or Organization(s):
City of Huntington Beach, its officers, elected or appointed officials, employees, agents, and volunteers.
The Transfer Of Rights Of Recovery Against
Others To Us condition does not apply to the
Person(s) or organization(s) shown in the Schedule
,but only to the extent that subrogation is waived prior To the “accident” or the “loss” under a contract wi th
that person or organization.
CA 04 44 10 13 Page 1 of 1