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<br />.ilSECAC-Cl
<br />BWAYNE
<br />ACORO" CERTIFICATE OF LIABILITY INSURANCE
<br />GATE IMM 001YYYY1
<br />01/11/2019
<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 />Bolton 8: Com any
<br />3475 E. Foothill Blvd., Suite 100
<br />NONTAMEACT
<br />PHONE FAX
<br />INC, No, Eat): (626) 799-7000 INC, No):(626) 441-3233
<br />Pasadena, CA 91107
<br />E oalEss: propcasualty@boltonco.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A:Philadelphia lnsuranceCom an
<br />23850
<br />INSURED
<br />INSURER B: Now York Marine 8r General Ins. Co.
<br />16608
<br />INSURER C:
<br />Wiseplace, CA Corp. Wise Silver Center dba: ✓
<br />INSURER D:
<br />1411 N. Broadway
<br />Santa Ana, CA 92706
<br />INSURER E
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 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 SUBJECTTO ALLTHETERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TYPE OF INSURANCE
<br />ADDLSUBR INSD
<br />Me
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICYEXPLTIR
<br />LIMITS
<br />A
<br />X
<br />COMMERCUILGENERALLUIBIDTY
<br />CLAIMS -MADE X OCCUR
<br />X
<br />PHPK1924744
<br />01101/2019
<br />to
<br />0110112020
<br />16CH OCCURRENCE
<br />$ 1,000,O00
<br />DAMAGE TO RENTED
<br />REMISES lEa occunence
<br />100,000
<br />$
<br />MED EXP LAny oneperson)
<br />6,000
<br />PERSONAL a ADV INJURY
<br />$ 1,000'000
<br />AGGREGATE LIM IT APPLIES PER:
<br />POLICY ❑ jE LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />PRODUCTS -COMPIOPAGG
<br />$ 2,000,000
<br />SEXUAL PHYSICAL
<br />11000,000
<br />OTHER:
<br />A
<br />AUTIMOBILELIABIUTY
<br />aeBndeO SINGLE LIMIT
<br />$ 1,000,00
<br />BODILY INJURY Per erson
<br />$
<br />ANY AUTO
<br />PHPK19247"
<br />01/0112019
<br />0110112020
<br />BODILY INJURY Peraccumar
<br />$
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />Parrm d AMAGE
<br />$
<br />X
<br />VyNE
<br />AUTOS ONLY X A� OS ONLB
<br />a
<br />A
<br />X
<br />UMBRELLA UAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />I
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />I CLAIMS -MADE
<br />PHUB660328
<br />01/0112019
<br />0110112020
<br />DED I X I RETENTION$ 10,000
<br />Aggregate
<br />$ 1,000,000
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'I-MBIUTY YIN
<br />OFFICEWMEMBEgwqEXCLUDED?ECUTIVE ❑
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />WC201800006833
<br />0811512018
<br />OB/15/2019
<br />SEATUTE OTH-
<br />E.L. EACHACCIDENT
<br />1,000,00
<br />$
<br />E.L. DISEASE -EA EMPLOYEE
<br />$ 1,000,000
<br />.L. DISEASE - POLICY LIMIT
<br />1,OD0,000
<br />$
<br />A
<br />Professional Liabili
<br />PHPK1924744
<br />0110112019
<br />01101/2020
<br />A
<br />Crime
<br />PHPK1924744
<br />O'1/01/2019
<br />01101 /2020
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />GL Additional Insured applies per CG20130413 attached, only if required by written contract/agreement.
<br />Primary and Non -Contributory Wording applies per PIGLOO50712 attached.
<br />Additional Insured(s): Cify of Santa Ana, its officers, employees, agents, volunteers and representatives.
<br />RE: Operations of the named insured.
<br />I-15�1�
<br />CERTIFICATE HOLDER CANCELLATION u
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />J
<br />i
<br />I
<br />ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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