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<br />ACORCs"
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IY y
<br />111141(MM200.1
<br />11194t2018
<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 License 9 OK07568 CONTACT
<br />Pacific Diversified Insurance Services °"NF
<br />are,o. Eag�9j686-2860 [FAX No
<br />925-686-2860 ,-
<br />363 Civic Drive Suite 100
<br />Pleasant Hill, CA 94523
<br />INSURER S AFFORDING COVERAGE NAIC #
<br />INSURER A; National Union Fire Insurance Company of Pittsburgh, PA 19445
<br />INSURED INSURER B:Travelers „Pro party Casualty Co. of America 25674
<br />RMA Group Inc. INSURER C ...........
<br />12130 Santa Margarita Ct. INSURER D
<br />Rancho Cucamonga, CA 91730
<br />INSURER E
<br />INSURER I:
<br />COVFRAQFS 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 />INS
<br />R TYPE OF INSURANCE ADDL SUeft INSO MD PO NUMBER IPOLM1ICY EFF POLICDY EXP LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000-
<br />CLAIMS-MADE CUR jt 4$1154$ 10t41t2018 0310172619 DAMAGE TG RENTED
<br />$ 300,OBB
<br />MED EXP M one arson 10,000
<br />_ PERSONAL &ADV INJURY 1,000,000
<br />GEN'L AGGREGATE LMIT APPLIES PER: GENERAL AGGREGATE 2,0BQ000
<br />POLICY EX]JERI8T LOC PRODUCTS-COMP/OPAGG 21000,100
<br />OTHER:
<br />A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
<br />X ANY AUTO 793502 10/0112/111 03/01/2019 BODILY INJURY Per arson _
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOSBODILYBODILY INJURY Per accident $
<br />AUTOS ONLY AU OS ONL� Pe1acatlem DAMAGE $
<br />B X UMBRELLA LIAR X OCCUR E EACH OCCURRENCE 3 12,000,000
<br />EXCESS LIAR I CLAIMS -MADE ZUP81NO493418NF 10/01/2018 0310112019 AGGREGATE 12,000,000
<br />DED X RETENTIONS 10,000
<br />A WORKERS COMPENSATION X I SEA UTE ER
<br />AND EMPLOYERS'LIABILTv YIN 014122658 10101/2018 03/0112019 1,OOQ000
<br />AW�� CERMEIMSKEXCLUDED?ECUTIVE ❑ NIA E,L EACH ACCIDENT
<br />(Mandatory In ) E.L. DISEASE - EA EMPLOYEE 1,000,000
<br />If yyes describe under 1,000,000
<br />DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, me be attached If more space is required)
<br />As required by written contract, the following endorsements apply to the Certificate Molder and/or any other entity named in this section: General Liability
<br />Additional Insured CG2010 04-13 and CG2037 04-13, Primary and Non -Contributory CG2001 04.13, Waiver of Subrogation CG2404 05.09; Auto Liability
<br />Additional Insured 0795010.05, Primary and Non -Contributory 7444510-99, and Waiver of Subrogation 62897 06-95 Per Project Aggregate 86681 09.04;
<br />Workers' Compensation Waiver of Subrogation WC040361 91.90.
<br />The City of Santa Ana, it officers, employees, agents and representative
<br />CERTIFICATF 1401 r1FR CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana
<br />THE ACCORDANCE WITH THE POLICY PROVISIONTION DATE THEREOF, TSCE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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