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N-zOi6-I-ts <br />IR4NI. CiLadi-.1y:7����3i1 <br />ACORD' CERTIFICATE OF LIABILITY INSURANCE <br />`.� <br />DATE (MMI001 Y) <br />O6/15I2018 <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 BYTHEPOLICIES <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 License # 0757776 <br />Santa Barbara, CA - HUB International Insurance Services Inc. <br />PO Box 3310 <br />Santa Barbara, CA 93130-3310 <br />N MEACT Diana Frausto <br />PHONE FAx <br />(AIC, No, Ext): (805) 679-9524 AIC,No:(805) 617-1762 <br />noDRess: Diana.Frausto@HUBinternational.com <br />INSURERS AFFORDING COVERAGE NAIC q <br />09101/2017 <br />INSURER A: West American Insurance Co 44393 <br />EACH OCCURRENCE $ 1.000,000 <br />INSURED <br />INSURER B: Ohio Security Insurance Company 24082 <br />INSURER C: American Fire and Casualty Company 24066 <br />HSG Inc <br />HSG, Inc DBA: Control Concepts <br />6925 Aragon Cir Ste 2 <br />INSURER D :Oak River Insurance Company 34630 <br />INSURER E: <br />Buena Park, CA 90620 <br />INSURER F: <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />W <br />X AI/T OS ONLY X AUTOS ONLY <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 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 ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />I TYPE OF INSURANCE <br />ADDL <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXP <br />LIMITS <br />A <br />X I COMMERCIAL GENERAL LI ABILITY <br />TC[LAIMS MADE ❑X OCCUR <br />BKW58251804 <br />09101/2017 <br />0910112018 <br />EACH OCCURRENCE $ 1.000,000 <br />PRESETO .cneMIS(Er,$ 500'000 <br />MED EXP An one erson $ 15'000 <br />PERBONALBADV INJURY $ 1'000'000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ PE8T F-;-,�] LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2'000'000 <br />PRODUCTS-COMP/OP AGG $ 2'600'000 <br />$ <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />W <br />X AI/T OS ONLY X AUTOS ONLY <br />BAS58251804 <br />09/0112017 <br />09/01/2018 <br />COMBINED SINGLE LIMIT 11000,000 <br />Ea accident <br />BODILY INJURY Perperson) $ <br />BODILY INJURY Per accident $ <br />PerOacclJ.rd AMAGE $ <br />C <br />X <br />UMBRELLA LIAB <br />EXCESSLIAB <br />[I <br />OCCUR <br />CLAIMS -MADE <br />ESA58251804 <br />0910112017 <br />0910112018 <br />EACH OCCURRENCE $ 2'000'000 <br />AGGREGATE 2'000'000 <br />DEDTX RETENTION $ 0 <br />D <br />WORKERS COMPENSATION <br />ANDEMPLOVERS'LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE Y <br />(rAFamiatory in NNS EXCLUDED? <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />HSWC909577 <br />02/0112018 <br />02101/2019 <br />PEROTH- <br />Xt I <br />E.L. EACH ACCIDENT 1,000,000 <br />E.L. DISEASE - EA EMPLOYEE 1,000,000 <br />1,000,000 <br />E.L. DISEASE- POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />The City of Santa Ana, it's officers, employees, agents, and representative are named as additional insured's under the general liability policy as coverage <br />applies when required by written contract per attached form #CG 88 10 0413. <br />7h�l rg Payer ld� <br />City of Santa Ana <br />Attn: Kathie Reyes <br />220 S. Daisy M-85 <br />Santa Ana, CA 92703 <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 />AUTHORIZED g , <br />REPRESENTATIVE <br />ACORD 25 (2016103) @ 1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />v <br />1 <br />