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Taizo CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDM'YY) <br />UI <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />n ols <br />6/16/2017 <br />ILTIR NSR <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 />ANSA <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 roquire an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endomemant(s). <br />POLICYNUMBER <br />PRODUCER Lockton Companies <br />Three City Place Drive, Suite 900 <br />St. Louis MO 63141-7081 <br />(314)432-0500 <br />N <br />LIMITS <br />P A <br />AIC No, Ext : AIC No <br />COMMERCIAL GENERAL LIABILITY <br />X <br />E-MAIEss: <br />N <br />SAF NGC VE <br />'AIC <br />OCCURRENCE 2,000,000 <br />wsulxERA: Greenwich lnslvance Com an <br />I'suReRe: ACE Arnerioan Insurance Com an <br />22322 <br />22667 <br />_ <br />INSURED `Cdhpw Chinpantas Ino. <br />1316349 5643N 5AZ 8530nue <br />Glendale AZ 85301 <br />INSURER Indemni Insurance Ca o£North America <br />43575 <br />IN a Starr hldemuil &Liabilit Com an <br />383]8 <br />PAEMISESEeoccuran�e <br />RER E: Indian Harbor Insurance Com an <br />36940 <br />INSURER <br />AAAAICAA <br />ItlVIVE FOR <br />THIS IS TO CERTIFY THAT THE POLICIES INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />UI <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED D <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />O <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAIDCLAIMS. <br />ILTIR NSR <br />TYPE OF INSURANCE <br />ANSA <br />SWVD UER <br />POLICYNUMBER <br />P%AC,Y EFF <br />MM oO <br />7/1/2017 <br />MMIOOY EXP <br />MMY <br />7/F/2018 - <br />LIMITS <br />A <br />COMMERCIAL GENERAL LIABILITY <br />X <br />Y <br />N <br />CGD300084902 <br />EACH <br />OCCURRENCE 2,000,000 <br />A <br />CLAIMS-MADE�OCCUR <br />XCU/BROAD FORM I'D <br />PAEMISESEeoccuran�e <br />lOOOOOO <br />MED EXP (Any oneperson) 10,()00 <br />PERSONAL & ADV INJURY IS 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ 4,000,000 <br />PRODUCTS-COMP/OP AGO $ 4,000.000 <br />POLICY �E�T 191 LOC <br />OTHER', <br />AUTOMOBILELWBILIV <br />ISAH09060947 <br />7/1/2017 <br />7/x/2018 <br />COMBINED <br />$2000000 <br />X <br />ANY AUTO <br />BODILY INJURY (Per pemon) $ XXXXXXX <br />OWNED L_JSCHEDULED <br />AUTOS ONLY AUOoTOS <br />BODILY INJURY(Peracodenl $ XXXXXXX <br />pp <br />AUTOS ONLY A11T090NEV <br />Pe acctlenA $ XXXXXXX <br />$XXXXXXXD <br />UMBRELLA LIAB <br />X <br />OCCUR <br />1V <br />1V <br />1000095154171 <br />7/1/2017 <br />7/1/2018 <br />EACH OCC$ 5000000EXCESS <br />LIAB <br />CLAIMS -MADE <br />AGGREGA$ 5 000 000DED <br />RETENTION$ <br />XXXXXXXWORKERS <br />BAND <br />COMPENSATION <br />EMPLOYERS' LIABILITY <br />N <br />( <br />WIJiC64413272 (WLRj)(CA/Ml()A) <br />7/1/2017 <br />7/1/2018 <br />X STATC <br />YIN <br />ANY OFFICER/MEMBEREXCWOCDEGUTIVE NNIA <br />7/1/2G1$EL <br />EgCH AG1 OOO t)OOMandatary <br />In Net <br />untle, <br />(EXCLIIDINGBMONOPOLISTl <br />)7/I/2H17 <br />/�Ityes.desaribe <br />EL. DISEASE1000000DESCRIPTION <br />OF OPERATIONS below <br />EL DISEgaE1000000 <br />E <br />Conti I'mf.Liab <br />N <br />N <br />CE0742002405 <br />7/1@017 ..7/1/2018 <br />PerPoucy. <br />E <br />COntr Poll. Liab <br />CPI,742035804 <br />7/1/2017 <br />7/I/20I8 <br />$10,000,000 per claim/Agg. <br />E <br />(PROF -CLAIMS MADE) <br />$500,000 SIR eaehlosa <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedula, may be attached if more space is required) <br />CITY OF SANTA ANA ITS OFFICERS, EMPLOYEES AGENTS AND EMPLOYEES ARE ADDITIONAL INSUREDS UNDER GENERAL <br />LIABILITY WHEN REpUIRED BY WRITTkiN CONTRACT, DU'C ONLY WI; CH RBSPRCT TO LIABILITY ARISING OUT OP THE NAMED <br />INSURED'S OPERATIONS XX 'SEE ATTACHED P.NI70RSEMENTS' <br />rcorinnnTM Unl nve <br />10593785 <br />CITY OF SANTA ANA <br />ATTN:PURCHASING DEPARTMENT <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701-4010 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />LF1 <br />ACORD 28 (2016/03) ©1988-1 700RD CO ONA <br />The ACORD name and logo are registered marks of ACORD <br />la/7R PxJc- j <br />