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ADMIINC-Cl MPERE7
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />°ATE/05/20"
<br />0905/208
<br />18
<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 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 endorsements .
<br />PRODUCER
<br />Bolton & Company
<br />3475 E. FOOthll' Blvd., Suite 100
<br />CONTACT
<br />NAME
<br />PHONE FAX
<br />(AIC, No, Ext: (626) 799-7000 AIc, No:(626) 441-3233
<br />Pasadena, CA 91107
<br />EMAIL . propcasualty@boltonco.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC4
<br />INSURER A: Sentinel Insurance Co.
<br />11000
<br />INSURED
<br />INSURERB:TWIn City Fire Insurance Co
<br />29459
<br />INSURER C: RLI Insurance Company
<br />13056
<br />AdminSure, Inc.
<br />INSURER D: United States Fire Insurance Co.
<br />3380 Shelby Street
<br />Ontario, CA 91764
<br />INSURER E:
<br />INSURER F:
<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 CONTRACT OR 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 />HER
<br />TYPE OFINSURANCE
<br />ArDDLSUBR SO
<br />MID
<br />POLICY NUMBER
<br />POLICY
<br />POLICY EXPLTR
<br />LIMITS
<br />A
<br />X
<br />COMMERCIALGENERALLIABILITV
<br />CLAIMS -MADE X OCCURIVI
<br />X
<br />72SBAUV7737
<br />10/05/2017
<br />10/05/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAM ETORENTEDnce
<br />$ 11000,000
<br />MED EXP= (Any oneperson)
<br />10.000
<br />PERSONAL & ADV INJURY
<br />11000,000
<br />GENT
<br />AGGREGATE LIMIT- APPLIES PER',
<br />POLICY Ex JECT1:1 LOG
<br />GENERAL AGGREGATE
<br />$ 2,000$000
<br />PRODUCTS - COMP/OP AGO
<br />$ 2,000,000
<br />OTHER'.
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1Ea accident
<br />$ 1 DOD goo
<br />BODILY INJURY Perperson)$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />72SBAUV7737
<br />10/05/2017
<br />10/05/2018
<br />BODILY INJURY Per accident
<br />$
<br />X
<br />W-11) adent AMAGE
<br />$
<br />AUTOS ONLY X AUTOS ONLY
<br />A
<br />UMBRELLA LIAR
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />72SBAUV7737
<br />10/05/2017
<br />10/05/2018
<br />EACH OCCURRENCE
<br />$ 4,000,000
<br />AGGREGATE
<br />$ 4,000,000
<br />DED X RETENTION$ 10:000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />p FICE/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />72WECNG7400
<br />01/01/2018
<br />0110112019
<br />y PER OTH-
<br />E
<br />E,L, EACH ACCIDENT
<br />$ 1,000,000
<br />E. L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />EL.DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Errors & Omissions
<br />RTPOO11178
<br />10/05/2017
<br />10/05/2018
<br />Ded. $25,000
<br />5,000,000
<br />D
<br />Crime
<br />6260363478
<br />10/13/2017
<br />10/13/2018
<br />Ded. $10,000
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />General Liability Blanket Additional Insured per SS00080405 attached, only if required by written contract/agreement.
<br />Additional Insured: The City, and their respective officers, agents and employees.
<br />CERTIFICATF HCI DFR rArdrl=l I Anna
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Clerk of the City Council
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M-30)
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />ACORD 25 (2016/03) © 1988.2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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