ACORD® DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 11/2/2022
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 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 endorsements).
PRODUCER Lynette (Lynn) Eye
PIA Select Insurance Solutions PHONE
A/C No, Ext): 805-975-3531 [NC, No):
E-MAIL
1100 Industrial Rd., #3 ADDRESS: [email protected] INSURER(S) AFFORDING COVERAGE NAIC #
San Carlos CA 94070 INSURER A : Amco Insurance Company 002014 INSURED ISURER B: Employers Assurance Ci 10346
Data Ticket, Inc. NSURER C : Continental Casualty Compan 20443 DBA: Revenue Experts INSURER D: North American Capacity Insurance Company 41297 2603 Main Street, Ste. 300 INSURER E: Travelers Casualty and Surety Company of America 31194 Irvine CA 92614-4200 INSURER F:
CERTIFICATE NUMBER: REVISION NUMBER:
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 X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s 2,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES (Ea occurrence) 100,000
MED EXP (Any one person) 5,000
A Y Y ACP GLO 3089509589 11/01/2022 11/01/2023 PERSONAL & ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 4,000,000 PRO-
POLICY JECT LOC PRODUCTS - COMP/OP AGG 4,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMI 1,000,000
Ea accident)
TANY AUTO BODILY INJURY (Per person)
OWNED 1 SCHEDULED 11/01/2023 BODILY INJURY (Per accident) S A AUTOS ONLY AUTOS ACP GLO 3089509589 11/01/2022
HIRED NON-OWNED
* AUTOS ONLY AUTOS ONLY
UMBRELLA LIAB OCCUR 2,000,000
EACH OCCURRENCE
A X EXCESS LIAB CLAIMS-MADE ACP CAA 3089509589 11/01/2022|11/01/2023 AGGREGATE 2,000,000
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? EIG4581764-03 11/01/2022 11/01/2023 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S 1,000,000 ESCRIPTIN OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 ee attached Additional Remark
chedule for additional policie
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is agreed the Certificate Holder listed below is included as Additional Insured including Waiver of Subrogation and Primary & Non-Contributory wording as required by written contract.
Workers Compensation includes a blanket Waiver of Subrogation (see attached).
CERTIFICATE HOLDER CANCELLATION
HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR "HE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I City of Redondo Beach ACCORDANCE WITH THE POLICY PROVISIONS. 415 Diamond AUTHORIZED REPRESENTATIVE
Redondo Beach, CA 90277 -
Attn: Lynn Gumacal
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