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.4coezv® CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MWDOnYYYI <br />1210712017 <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 />Michael ROdgick(971632A) <br />196 Technology Dr Ste B <br />CONTACT <br />A : Mike <br />NAIe_ <br />-jaglG,4��y. 949.753-9555 �_No(: <br />A00 IEys; <br />-m--m[ad*k@f0MI=gBDLcom---:.�_ _ <br />LBERG <br />S AINGCD_VERAG_E __ ____ N8100 <br />___ _ INSURERP CIRO _—_ <br />Irvine CA 92618-2433 <br />INSURERA: Truck Insurance Exchanqe 21709 <br />INSURED'----��--_v__-_�--i-----------__--INSURERBIFarmersInsuranceExchan9 <br />_ <br />216522 <br />-- <br />INSURERC: Mid Century Insurance Company <br />21667 <br />SANTA, ANA BUSINESS COUNCIL, <br />INSURER D: State Fund <br />1000000 <br />400 E. ATH STREET <br />INSURER E: Travelers Insurance _—~ <br />31194 <br />S 1,0001000 <br />INSURER F: v <br />---------- <br />SANTA ANA CA 92701 <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 AFFQROED 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 />NS <br />• TVPEOPINSURANCE <br />Ai1D fees <br />=8 <br />POLICY NUMBER <br />POUCYEYry <br />PO OOY E%P <br />LBERG <br />I GENERAL LIABILITY <br />X I COMMERCWL GENERALLIAMLITY <br />CIAIMS4ADE�OCCUft <br />T_--------- <br />EACH OCCURRENCE <br />S 1,000,000 <br />OAMAGEiO-FSTttT <br />1000000 <br />�S <br />S 10,000_ <br />PERSONALSADV INJURY <br />S 1,0001000 <br />B <br />---------- <br />Y <br />N <br />605503396 <br />12JO712017 <br />12/07/2018 <br />GENERALAOGREGATE <br />S 2,000.000 <br />GENL AGGREGATE <br />LIMIT APPLIES PER: <br />PRODUCTS�COMP(OPAGO <br />S 2,000,000 <br />POLICY <br />PRO. LOC <br />1i —_ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Son r'danll _ <br />1,000,000 <br />BODILY INJURY (Par person) <br />S <br />ANY AUTO <br />B <br />_ <br />ALL OWNED AUTOSULEO <br />NON -OWNED <br />HNiEDAUT05 X AUTOS <br />605503306 <br />12fO712D17 <br />12lD712018 <br />BODILY INJURY (Par noddan0 <br />S _ <br />PROPERTY O/IMAI;i'E+— <br />B -- <br />— — <br />S <br />UMBRELLA LIAa <br />OCCUR <br />EACH OCCUiiRENCE_ <br />5 <br />AGGREGATE___ <br />____ _ <br />EXCESS LIAR <br />CLAIAUSMADE <br />I <br />DED RETENTION S <br />5 _ <br />WORKERS COMPENSATION <br />OTH- <br />D <br />AND EMPLOYERS'LIABILnY YIN <br />ANY PROPIUETORIPARTNEPfEXECtrrvE = <br />OFFTCEWMEMSER EXCLUDED? <br />tMandatorylnNH) <br />Iryee,describe Under <br />0 SCRIPTI N OF OPERATIONS Wire, <br />NIA <br />9081384 <br />17/1012017 <br />12110/2018 <br />I- IIORY.I-IMIl9.1.1 <br />EL EACH ACCIDENT <br />--- <br />E.L. DISEASE -EA WPLOYEE <br />_-. <br />S 1_000_000 <br />— <br />S1,000,000 <br />151.OISEASE-POLICY LIMIT <br />- <br />S — 1,000,00D <br />E <br />Fidelity Bond <br />D&O <br />106032811 <br />12!1012017 <br />12110/2018 <br />5,000 SIR $500,000 <br />1,000SIR $1,000,000 <br />EPL <br />1,000 SIR $1,000,000 <br />DESCRIPTONOFOPERATIONSILOCATIONSIVEHICLES (Attach ACORO VII, Additional Remarks Sem,dulo. If mom spaeo is required) <br />400 E. 4TH STREET, SANTA ANA, CA 92701 <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL LIABILITY <br />PURPOSES. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY, WITH THIRTY (30) DAYS NOTICE OF CANCELLATION, EXCEPT 10 DAYS FOR <br />NONPAYMENT OF PREMIUMS <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2010105) 01988.2010 ACORD CORIPbRAT10%. A71 rights ieserved. <br />The ACORD name and logo are registered marks of ACORD <br />25Q-21 <br />SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE <br />CITYOFSANTAANA <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />20 CIVIC CENTER PLZ <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />SANTA ANA CA 92701 <br />ACORD 25 (2010105) 01988.2010 ACORD CORIPbRAT10%. A71 rights ieserved. <br />The ACORD name and logo are registered marks of ACORD <br />25Q-21 <br />