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Aa"9I'- R CERTIFICATE OF LIABILITY INSURANCE <br />HATE (MM/0IYYYY) <br />ot1o412o16 <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 pollcy(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 />CONTACT Danielle Niheu <br />NAME: <br />Select5olutlons Insurance Services <br />aic°sE A,u, (666)500-6369 Bolo (925)951-0077 <br />1107 Investment Blvd <br />.-rep" SS: daniellenCgselectsolu8onsins.com <br />ADDRE <br />Suite 100 <br />INSURERS) AFFORDING COVERAGE NAIC a <br />EI Dorado Hills CA 95762 <br />INSURERA: Philadelphia Consolidated Holding Corp <br />INSURED <br />INSURER e: New York Marine&General Insurance 16608 <br />Wlseplace, a Ca Corp <br />INSURER C: <br />1411 N, Broadway <br />INSURER 0: <br />INSURERE: <br />Santa Ana CA 92706 <br />INSURERF <br />COVERAGES CERTIFICATE NUMBER: i (rid a inns Master REVISION NUMBER - <br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FORTHE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 ALLTHE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />ITR <br />TYPE OF INSURANCE <br />20 Civic Center Plaza, M-25 <br />POLICYNUMOER T <br />MMIDDNCY YYY <br />MMIOpNYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />CI -AIMS -MADE OCGUR <br />EACHOCCURRENCE S 1.000,000 <br />PREMISES Ea occunenre s 100,000 <br />MEDEXP(An ane person) $ 5,000 <br />�_..._._ <br />PERSONAL anov INJURY $ 1,000,000 <br />A <br />Y <br />PHPKI758146 <br />01/0112018 <br />01/01/2019 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />X POLICY ❑ JERCT PO• El LOC <br />GENERALAGGROGATE s 2,000.000 <br />PRODUCTS-COMPIOPA00 S 2,000,000 <br />S <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />E MBINEODaINGLE LIMIT S 1,000,000 <br />X <br />ANY AUTO <br />BODILY INJURY(Perperson) $ <br />A <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />PHPK1758146 <br />01101/201II <br />01101/2019 <br />BODILY INJURY PeracddeN) g <br />( <br />HIRED NON -OWNED <br />AUTOSONLY AUTOS ONLY <br />PROPERTY DAMA $ <br />1per acddenl <br />..WW <br />Collation $ 1,000 <br />X <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />I <br />EXCESS LIAB <br />CLAIMS -MADE <br />PHUB613132 <br />01/01/2016 <br />01/0112019 <br />AGGREGATE $ 11000,000 <br />OED LX RETENTION S 10,000 <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNEWEXECUTIVE <br />OFFICEWMEMBER EXCLUDED? ❑ <br />(Mandatary In NH) <br />If yes, deacdbe andar <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />WC201700006B33 <br />08li512017 <br />08115r20i8 <br />PER ETH. <br />x STATUTE ER <br />EL�EACH ACCIDENT $ 11000,000 <br />E.L. DISEASE - EA EMPLOYEE S 1,000,000 <br />E.L. DISEASE - POLICY LIMIT $ 1,000,D00 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS l VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) <br />City of Santa Ana Is Included as additional insured on General Liability policy PBT attached endorsement. General Liability coverage Is <br />primary and non-contributory per the attached endorsement. The Professional Liability Limits shown represent the per claim/aggregate limits <br />of Ilabllity. <br />CERTIFICATE HOLDER CANCPI I ATICIN <br />1v11988�2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <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, Community Development Agency <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M-25 <br />— <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701 <br />`". <br />1v11988�2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />