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N-L®ls.153 i�—`s`N ORANCOU-06 PRIETOP ACOKO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 01/31/2019 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 PRODUCER """.."o' — IDA Insurance Services 130 Vantis Suite 250 Aliso Viejo, CA 92656 INSURED Orange County Fire Protection 137 W. Bristol lane Orange, CA 92865 CONTACT Albert Lum NAME: INCD,, N N. Ert): (949) 660.1781 52014 - FAX No):(949) 297-596D E-MARSS al.lum loausa.com ADDRE _ INSURER(S) AFFORDING COVERAGE NAICA INSURER .B;Philadelphia Indemnity Insurance Company _18058 INSURER f -Everest National Insurance Company 10120_ INSURER D rrYVFDArFR rCDTICIr ATF MIIMDCD- Dcvlclnkl kInMDCD. 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 LTR TYPE OF INSURANCE ADOINSLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000+006 CLAIMS -MADE X OCCUR X X PPK1781002 02/28/2018 07/01/2019 DAMAGE TO GES RoNTEDencel 8 106'000 PREMMED EXP (Any one perwn $ 5,000 PERSONAL & ADV INJURY $ 1,666,666 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE __$ 2,000,000 POLICY X JEo- LOC PRODUCTS - COMP/OP AGG S 2,000,000 OTHER: Deductible $ 5,000 B AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1 000 goo _ JEa accident/ _ $ X ANY AUTO X X PHPK1781733 02/28/2018 07/01/2019 BODILY INJURY (Per person) $ _ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S _ X HIRED X NON -AWNED PROPERTY DAMAGE _AUTOS ONLY AUTOS ONLY (Per accident) S X Ded Comp. $500 X Ded Call. $1,000 9 A UMBRELLA LIAR X OCCUR EACH OCCURRENCE _$ 4.000,000 X EXCESS UAB CLAIMS -MADE PUB618666 02/26/2016 07/01/2019 AGGREGATE $_ 4.060,000 DED X RETENTION$ 0 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER _- ANYPROPRIIETORIPARTNEMEXECUTIVE Y NIA X 5300003485181 07/01/2018 0]/01/2019 11000,0001 (Mandatory in NHR EXCLUDED? _ E.L. EACH ACCIDENT 5 1,000,000 E.L. DISEASE - EA EMPLOYEE 5 If yes, describe under 1,600,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, ma be attached if more space is required) The City of Santa Ana, it's officers, employees, agents, and representative are includyed as an Additional Insured for General Liability and Auto Liability with respect to work performed for them by the Named Insured as required by written contract, per Blanket Additional Insured endorsement Nos. CG 20 10 0413, CG 20 37 04 13 and PI -CA -001 (05/10). Liability Coverage is Primary and Non -Contributory, per endorsement No. PIC-GLN-036 (08/14). Blanket Waiver of Subrogation applies to General Liability, Auto Liability and Workers' Compensation coverages, per Endorsement Nos. CG 24 04 05 09, PI -CA -001 (05/10) and WC 040306. Per Project Aggregate Endorsement per form PIC-GLN-028 (08/14). 30 Days Notice of Cane�{.��( I thj s Notice for Non•Praa ment of Premium in accordance with the policy provisions. 1 \r V I � Y V E D b Y. City of Santa Ana Public Work Agency 20 Civic Center Plaza SHOULD ANY OF TH2 AdOYlWLB6C16G* CANDLED -BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �'�""'^ 'e K �to. ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Y K V