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HSGINCO-01 DFR STO AoIC"R® _ DATEY ) �CERTIFICATE OF LIABILITY INSURANCE 06/1512018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER License # 0757776 CON TACT Diana Frausto Santa Barbara, CA - HUB International Insurance Services Inc. •PHONEFAX PO Box 3310 ; (AIC, No. Ext� 805) 579-9924 {AC, Nu):(805) 617-1762 Santa Barbara, CA 03130.3310AD ISS Diana. Frausto(g�HUBinternationa ccom INSURER S AFFORDING COVERAGE NAI p N2018-145 INSURER A :West American Insurance Co 44393 INSURED INSURERS Ohio Security Insurance COmpaan 24062 HSG Inc INSURER c.: American Fire and CasualinvCompany 24066 HSG, Inc DBA: Control Concepts 6925 Aragon Cir Ste 2 INSURER D:Oak River Insurance Company34630 Buena Park, CA 90620 INSURER E_.. _ C0VFRAGFIq CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR) TYPE OF INSURANCE ADI! SAAR POLICY NUMBER POLICY EFF MICONVYYi CY£XP _ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE_ $ 1'000'000 CLAIMS -MADE � OCCUR BKW58251804 09/01/2017 091011201$ DAMAGE TO RENTED ' 56-01000 PREMISES Eao IaUAge 15000 MED EXP (Anv onearson) . $ 1'00-0,000 PERSONAL B ADV INJURY 2'000'000 G£N'LAGGREGATELtMiT APPLIES PER: , GENERALAGGR GAty,,,,_ $_ _— [_] � 21000'000 FOLtCY Ppe LOC PRODUCTS-COUPIOP AGG $ OTHER: $ _ B AUTOMOBILE LIABILITY COMBINED t SINGLE LIMIT $ 1,000,000 (EoX ANY AUTO BAS58251804 09101/2017 091011201$ BODILVINJURv (Per arnon $ OWNED SCHEDULED _ AUTOS ONLY AUTOS BODILY INJURY(Peraoaitlent $ _ .X AIUTQS X MON-OWNED a -, �i0Ptl8 { AMAGE a _... ONLY 1NiUT08 1 sr _ $ C UMBRELLA LIARX OCCUR I _ EACH OCCURRENCE _ $ 2'000'000 X EXCESS LIAB CLAIMS -MADE- ESA58251804 09101/2017 09/01/2018 AGGREGATE $ 2'000'000 _.... DED X RETENTION$ 0 _ D WORKERS COMPENSATION X PER ER EMPLOYERS LIABILITY HSWC909577 02101/2018 02!0112019 YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTNE Y MIA E-L-FACY-ACCIDENT$ _ MEWEXCLUDED? UDEC? 1,000,000 (Mantlatog m NH} 7 EL DISEASE- EA EMW,6YE _._ If Yes, descrinuan,.r I _ 1,099,990 DESCRIPTION OF OPERATIONS below EL DISEASE - POLI YLIMIT i DESCRIPTION OF OPERATIONSf LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, Its officers, employees, agents, and representative are named as additional insurad's under the general liability policy as coverage applies when required by written contract per attached form #CG 8810 0413. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Kathie Reyes 220 S. Daisy M-85 — - --- Santa Ana, CA 92703 AUTHORIZED REPRESENTATIVE 1 4"=41L_.... _..... ACORD 25 (2016103) V) 1988-2015 ACOKD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V f