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2491717 Civic LLC Certificate Of insurance 10/31/2018 3:38:08 PM
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<br />A� RO® CERTIFICATE OF LIABILITY INSURANCE
<br />°AT0/MM/2018
<br />10/31/2018
<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 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 />CONTACT
<br />NAME:
<br />PH
<br />A/c°NN Ext: (800) 301-6256 AIC No: 877-826-9067
<br />E-MAIL
<br />ADDRESS:
<br />Insurson (BIN Insurance Holdings LLC.)
<br />30 N. LaSalle, 25th Floor, Chicago, IL 60602
<br />INSURERS AFFORDING COVERAGE NAIC p
<br />INSURER A: The Hartford 30104
<br />EACH OCCURRENCE $ 1,000,000
<br />INSURED
<br />INSURER B: The Hartford 30104
<br />INSURER c: HISCOX 10200
<br />CIVIC LLC
<br />INSURER D
<br />1198 Pacific Coast Highway Suite 205, Seal Beach, CA, 90740
<br />INSURER E:
<br />DAMAGE TO RENTED 1 ,000,000
<br />PREMISES Ea occurrence $
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIODIYYVY
<br />POLICY EXP
<br />MMIDDIYYYV
<br />LIMITS
<br />COMMERCIALGENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIM
<br />A CLAIMS -MADE � OCCUR
<br />DAMAGE TO RENTED 1 ,000,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ 10,000 -
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />A
<br />Yes
<br />46SBMUQ8455
<br />7/1/2018
<br />7/1/2019
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />✓ POLICY PRO- ❑
<br />ECT LOC
<br />PRODUCTS - COMPIOP AGO $ 2.000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />ANYAUTO
<br />ALL OWNED F7 SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Per accident
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />$
<br />UMBRELLA LIPS
<br />✓
<br />OCCUR
<br />EACH OCCURRENCE $ 2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />Yes
<br />46SBMUQ8455
<br />7/1/2017
<br />7/1/2019
<br />AGGREGATE $ 2,000,000
<br />DED RETENTION$
<br />$
<br />--=WORKERS
<br />:COMPENSATION✓
<br />EMPLOYERS' LIABILITY YIN
<br />STATUTE
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />B
<br />OFFICERIMEMBER EXCLUDED?ANY PROPRIETORNPARTNEWEXECUTIVE No
<br />NIA
<br />46WECAR3260
<br />629/2018
<br />6/29/2019
<br />E. L. DISEASE - EA EMPLOYE $ 1,000,000
<br />(Mandatary In NH)
<br />If yes, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000p00
<br />C
<br />Professional Liability (Errors and Omissions)
<br />UDC -2228924 -EO -18
<br />4/13/2018
<br />4/13/2019
<br />Occurrence/Aggregate $1,000,0001$1,000, 00D
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be altac had If more space Is req bled)
<br />Certificate Holder is named as Additional Insured astheir interests may appear in regards to General Liability.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2016/03)
<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 REPRESENTATIVEA//�� -
<br />/ IF fye�.i
<br />ACORD 25 (2016/03)
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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