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A� OF CERTIFICATE OF LIABILITY INSURANCE UUv1
<br />DATE
<br />S/(6/20 8 )
<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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />NAME: CONTACT Jayna Mullett
<br />E 1. (269) 344-0433 FAX
<br />. WC No: (269)399-6]86
<br />Lighthouse Insurance Group, Inc.AHONN
<br />E-MAIL
<br />ADDRESS:
<br />527 S Rose St
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A:Hartford Casualty Insurance Cc 29424
<br />Kalamazoo MI 49007
<br />INSURED
<br />INSURER B:Sentinel Insurance CO LTD 11000
<br />INSURER C:Multi le Hartfaord Companies 00914
<br />Benefit Administrative Service International Corp
<br />INSURER D:Landmark American Ins. Co.
<br />9246 Portage Industrial Drive
<br />INSURER E :
<br />INSURER F:
<br />Portage MI 49024
<br />COVERAGES CERTIFICATE NUMBER:18-19 Master 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 />INSR
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ADDLTYPE
<br />SUn
<br />AUTHORIZED REPRESENTATIVE
<br />POLICY EFF
<br />CY EXP
<br />TR
<br />OF INSURANCE
<br />Nsp
<br />POLICYNUMBER
<br />MOI� DIYYYY LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />I—IX
<br />DAMAGE TO RENTED 300,000
<br />A
<br />CLAIMS -MADE OCCUR
<br />PREMISES Eaoccurrence $
<br />X
<br />81SBAIJ4464
<br />1/1/2018
<br />1/1/2019 MED EXP (Any one person) $ 10,000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />X POLICY PRO- LOC
<br />ECT
<br />PRODUCTS - COMPIOP AGG $ 2,000,000
<br />OTHER
<br />Employee Benefits $ 2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />MBINED SINGLE LIMIT $ 1,000,000
<br />(Ea accidentl
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />B
<br />ALLOWNEDSCHEDULED
<br />AUTOS AUTOS
<br />BlUCBK1251
<br />1/1/2018
<br />1/1/2019 BODILY INJURY (Per accitlent) $
<br />HIREDAUTOS AUUTOSWNED
<br />Pe a cldent AMAGE $ 1,000
<br />Uninsured motorist combined $ 1,000,000
<br />X
<br />UMBRELLA LIAB
<br />1 X
<br />OCCUR
<br />BISBAIJ4464
<br />1/1/2018
<br />1/1/2019 EACH OCCURRENCE $ 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Excluding LHR761187
<br />AGGREGATE $ 51000,000
<br />DED X RETENTION$ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />ANDEMPLOYERS* LIABILIW YIN
<br />STATUTE ER
<br />ANY PRO PRI ETORPARTNEREXECUTIVE
<br />E. L. EACH ACCIDENT $ 1,000,000
<br />C
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />BIWECCC3978
<br />1/1/2018
<br />1/1/2019 E, L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT $ 1,000,000
<br />D
<br />Professional Liability
<br />LHR761187
<br />7/1/2018
<br />7/1/2019 $2,000,000 Ea Claim $25,000 Ded
<br />$2,000,000 Aggregate
<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 representatives are named as additional
<br />insured in regards to the General Liability. 30 Day notice of cancellation will be provided.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014101)
<br />INS025 (201401)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Jayna Mullett/JMULLE���
<br />ACORD 25 (2014101)
<br />INS025 (201401)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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