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CERTIFICATE OF LIABILITY INSURANCE I DATE
<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 INSUREDS), 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 ileu of such ondorsement(s).
<br />PRODUCER
<br />Michael Rodgick(971832A)
<br />196 Technology Dr Ste B
<br />INSURED
<br />SANTA, ANA BUSINESS COUNCIL, �IN
<br />uREn c: Mid Centurry nsurar
<br />400 E, 4TH STREET _URERD: State FuuRER E, Travelers Insurance
<br />r474:iif367�ii�dlillTifl�:i
<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 />_
<br />INSRPOLICY F POLICYEXP 7
<br />(MWDD
<br />TR TYPEOF INSURANCE POLICY NUMBER OIYYY(I^ UNITS
<br />LIABILITY
<br />I��-G---E;
<br />EACH OCCURRENCE
<br />S 1,000,000
<br />yNyERAL
<br />XICOMMERCIAL GENERAL LIABILITY
<br />DAMAGE OWeNfESI
<br />"
<br />PREMISES dt4gerom-FE)
<br />I
<br />B
<br />` r LLj CLAIMS -MADE E OCCUR
<br />k
<br />Y N'
<br />Bp5503395
<br />I
<br />! 12107t2018
<br />j 12/07/2019
<br />MEtl EXP Any one arson
<br />PERSONAL &ACVINJURY
<br />S 10,000
<br />9 1,OOQ,000
<br />i
<br />GENERAL A44REGATE
<br />S 2,000,000
<br />GEN'LAGORC4ATE LIMIT APPLIES PER:
<br />FRO-
<br />I
<br />PRODUCTS AGO
<br />S 2,000,000
<br />POLICY IF JECT LOC
<br />( S
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO __
<br />ALLOWNED SCHEDULED
<br />AUTO$ _ AUTOS
<br />X NON•OWNED
<br />HIRED AUTOS /\ AUTOS
<br />I -
<br />(
<br />605503396
<br />112107/2018,
<br />I
<br />12/07/2019
<br />COMBINED SINGLE LIMIT
<br />L(Ea-mp t)---------
<br />BODILY INJURY (Per Pemon}
<br />i
<br />�6000.Y1NJURv iPar aeddant)
<br />PROPERTY NAMAGE
<br />1Per occidon9___
<br />I S 1,pp0,Qp0
<br />S
<br />"— —"
<br />s
<br />$
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<br />s
<br />UMBRELLA UAa I 'OCCUR
<br />C
<br />I
<br />I EACH OCCURRENCE
<br />IS
<br />EXCESSUAa CLAIMa•MADE
<br />...__-a ,..
<br />' ___._._1
<br />1
<br />I
<br />I
<br />I
<br />!
<br />'.
<br />I
<br />-AGGREGATE
<br />_.
<br />!S
<br />j 9ED RETENTION S
<br />I WORKERS COMPENSATION
<br />I AND EMPLOYERS' LIABILITY YIN,
<br />I
<br />V WC STATU- OTH�
<br />_ �S9RY.IJMITS.
<br />D
<br />ANYCCMALETOR EXCLUDED? CUTIVE
<br />_CF7ICEorymN REXCLUOEDi
<br />, NIA
<br />9Q81384
<br />1271 pj2p18
<br />12/1 Ql2Q19
<br />E L EACH ACCIDENT
<br />— —
<br />S 1 p00,p00
<br />— - -
<br />-(Mandatory In NN)
<br />!
<br />1
<br />( I
<br />pl bIBEASE-FA EMPLOYERS
<br />11006600
<br />Ryes, daocriunder
<br />DEBDRIPTIGNOF OPERATIONS babes
<br />)
<br />I
<br />I
<br />`
<br />E.L. DISEASE POLICY LIMITIS
<br />1,pQp,000
<br />Fidelity Bond
<br />5,000 SIR $500,000
<br />E
<br />D&O
<br />(
<br />1 100032811
<br />12/10120181121i
<br />Qt2019
<br />1,OQ6 SIR $1,000,000
<br />EPL
<br />I
<br />1,000 SIR $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attend, ACORN 101, Additional Remarks Scl o ludo, it more space 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 CIVIC CENTER PLZ ACCORDANCE WITH THE POLICY PROVISIONS.
<br />....-..._�.�n...,e...............
<br />AUTHORIZED REPRESENTATNE
<br />SANTA ANA CA 92701 ..-., _ - - - , // rrJ - f
<br />25 (2010105) ©1988-2010 ACORD
<br />01
<br />The ACORD name and logo are registered marks of ACORD
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