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ACORa CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDf/YYY) <br />Ill <br />05/31/2016 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS <br />CERTIFICATE ODES 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME: <br />Automatic Data Processing Insurance Agency, Inc. <br />WC. PHONE <br />E.Ur (A/C, No): <br />EMAIIU <br />ADDRESS: <br />1 Atlp Boulevard <br />Roseland, NJ 07008 <br />INSURER(S) AFFORDING COVERAGE NAICN <br />INSURER A: State Compensation Insurance Fund 3$076 <br />PERSONAL &ADV INJURY $ <br />INSURED <br />NSURERB: <br />NEUTRAL GROUND <br />$ <br />1733 VALENCIA <br />INsuRER c <br />INSURER D: <br />Santa Ana, CA 02706 <br />E <br />IINSURER <br />NSURER F <br />COVERAGES CERTIFICATE NUMBER: 91009/ 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 />I NOICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAYBE 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 />LTR <br />TYPE OF INSURANCE <br />ADDLISUER <br />SD <br />D <br />POLICY NUMBER <br />FF <br />MMIDnmYY <br />Ml <br />LIMITS <br />Santa Ana, CA 92701 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MAOE 171 OCCUR <br />EACH OCCURRENCE $ <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person) $ <br />PERSONAL &ADV INJURY $ <br />OENL AGOREGATE LIMIT APPLIES PER: <br />POLICY F7 jCCOT LOC <br />OTHER: <br />GENERAL AGGREGATE $ <br />PRODUCTS •COMP/OP AGO $ <br />$ <br />AUTOMOBILE <br />LIA51LITYBI <br />ANY AUTO <br />ALL OS AUTOSSCHEDLED <br />AUTOS AUTOS <br />HIRED AUT03 NOjl'p WNED <br />ED SINGLC-L dIT $ <br />Ea accident <br />BODILY INJURY (Per person) $ <br />BODILY INJURY Per accident $ <br />( ) <br />PROPERTY DAMAGE $ <br />Per eccldant <br />_„-„ <br />UMBRELLA LIAB <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />OED <br />RETENTION$ <br />$ <br />A <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY YfN <br />ANN PROPRIETOR/PARTNERIEXECUTIVE <br />OPricEWMEMBSR EXCLUDED? ❑Y <br />(Mandatory In NH) <br />If V.S. describe under <br />DESCRIPTIONOFOPERATIONSbel. <br />NIA <br />N <br />9221268.2017 <br />11/13/2017 <br />11113/2018 <br />X PER Ul - <br />HERER <br />C.L. EACH ACCIDENT $ 1,000,000 <br />EL. DISEASE - EA EMPLOYE $ 1,000,000 <br />— <br />E, L, DISEASE -POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarks Schedule, maybe attached If more apace Is required) <br />pv�1`ln' <br />V <br />CERTIFICATE HOLDER CANCELLATION <br />A© 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana <br />Y <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Attn: Terri Eggers <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />A© 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />