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A p® CERTIFICATE OF LIABILITY INSURANCE
<br />E (MMIDDIYY
<br />DAr4113/20 8Yv)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Dealey, Renton & Associates
<br />DRA License 0020739
<br />CONTACT
<br />Marie SwaneyRA
<br />PHONE
<br />. 626-844-3070 AIX No
<br />E-MAIL
<br />mswane deale renton.com
<br />199 S Los Robles Ave Ste 540
<br />Pasadena CA91101
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: American Automobile Ins. Co.
<br />21849
<br />INSURED URBANCROS
<br />Urban Crossroads, Inc.
<br />260 E Baker St, #200
<br />INSURER B: Travelers Casualty & Surety Co. America
<br />31194
<br />INSURER C: Valley Fore Insurance Company
<br />20508
<br />INSURER D: Continental Insurance Company
<br />35289
<br />Costa Mesa, CA 92626
<br />949-606-1994
<br />INSURER E: National Fire Insurance Cc of Hartford
<br />20478
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 544408614 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />AODLSUBR
<br />I D
<br />VD
<br />POLICYNUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br />C
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />Y
<br />Y
<br />6021297176
<br />11/112017
<br />11/l/2018
<br />EACH OCCURRENCE
<br />$2,000,000
<br />OHMAGE TO RENTE
<br />PREMISES Ee occurrence
<br />$1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$10,000
<br />Contradual Liab
<br />X
<br />XCU Included
<br />PERSONAL &ADV INJURY
<br />$2,000,000
<br />GENL
<br />AGGREGATE LIMITAPPLIES PER:
<br />POLICY�PEA LOC
<br />GENERAL AGGREGATE
<br />$4,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$4,000,000
<br />1
<br />$
<br />OTHER
<br />E
<br />AUTOMOBILELIABILITY
<br />Y
<br />V
<br />6020089431
<br />11/1I2017
<br />11Ii12018
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$I, Dog 000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accldonp
<br />$
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />D
<br />X
<br />UMBRELLALIA13
<br />X
<br />OCCUR
<br />Y
<br />Y
<br />6020089476
<br />11/1/2017
<br />11/1/2018
<br />EACH OCCURRENCE
<br />$2,000,000
<br />AGGREGATE
<br />$2,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X I RETENTION$ p
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />WZP81042875
<br />11/1/2017
<br />11/1/2018
<br />X I STATUTE EORH
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANVPROPRIETOR/PARTNEWEXECUTIVE ❑
<br />OFFIC ER/M EMBER EXCLUDED?
<br />N/A
<br />E.L. DISEASE -EA EMPLOYEE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT
<br />$1.000,000
<br />B
<br />Pmfesaional Liability
<br />105517965
<br />11/112017
<br />11/1/2018
<br />$1,000,000
<br />Per Clair,
<br />$2,000,000
<br />Annual Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Umbrella policy is a follow form to underlying Policies: General Liability/Auto Liability/Employers Liability.
<br />RE: All operations of the named insured -- City of Santa Ana, its officers, employees, agents, and representatives are named as additional insured as respects
<br />general and auto liability for claims arising from the operations of the named insured as required per written contract or agreement. General Liability is
<br />Primary/Non-Contributory per policy form wording. Insurance coverage includes waiver of subrogation per the attached endorsement(s).
<br />CERTIFICATE HOLDER CANCELLATION 30 Day Notice
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana, its officers, employees, agents, and
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />representatives
<br />Attn: Purchasing Division
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />ACORD 25 (2016/03)
<br />© 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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