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ACC)Rbr CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />01/23/2019
<br />THIS CERTIFICATE IS ISSUED ASA 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 endomement(s).
<br />PRODUCER
<br />Insurance Solutions
<br />License 40746539
<br />33302 Valle Rd, Suite 200
<br />San Juan Capistrano CA 92675
<br />CONTACT Kimberely Kelley
<br />NAME:
<br />PHONE(849)348-7400 (042)348-2373
<br />IC o �CiNoL )
<br />ADORESa, KImKQns-SOIUIIOne.COm
<br />INSURERIS)AFFORDING COVERAGE NAIGIII
<br />INSURERA: Onto Security Ins. CO. �- 24082
<br />INSURED
<br />INSURER e; American Fire and Casualty Company 24066
<br />,ALJ
<br />Professional Sports Field Maintenance, Inc �'c a
<br />q /
<br />INSURER C: State Comp Ins Fund 35076
<br />29486 Ridge Rd- __,01J�_ L
<br />INSURER D:
<br />ve,—aou - b13
<br />HNSURER E:
<br />San Juan Capistrano CA 92675
<br />INSURER F:
<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 MAYBE 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 />LSR
<br />TR
<br />TYPE OF INSURANCE
<br />AUDI,
<br />INSO
<br />SUER
<br />MD
<br />POUOYNUMBER
<br />MM DD YFF
<br />MMIDq VYYY
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MAGE FRI OCCUR
<br />_
<br />EACHOCCURRENCE S 1,000,000
<br />PREMISES Ea occF�cel S 500,090
<br />MEC EXP (Any one person) 5 15,000
<br />A
<br />SKS59328473
<br />11/01/2018
<br />11/01/2019
<br />PERSONAL enov INJURY S 1,000,000
<br />GEN'LAGGREGATE LIMITAPPUES PER:
<br />X POLICY ❑ PRO- ❑
<br />JECT LOC
<br />GENERALAGGREGATE S 2,000,000
<br />PRODUCTS-COMP/OPAGG S 2,000,000
<br />OTHER:
<br />Package Modification s
<br />AUTOMOBILE
<br />LIABILITY
<br />CGMGINEO SINGUELIMIT S
<br />Ee acdde t
<br />ANVAUTO
<br />BODILY INJURY (Per person) S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON OWNED
<br />AUTOS ONLY AUTOSONLY
<br />BODILY INJURY(Per acGdant} S
<br />PROPERTYA A $
<br />Par accident
<br />3
<br />B
<br />X
<br />UMBRELLA LIAR
<br />EXCESSUAB
<br />X
<br />OCCUR2,000,000
<br />CLAIMS -MADE
<br />USA59328473
<br />11/01/2018
<br />11/01/2019
<br />EACH OCCURRENCE 5
<br />AGGREGATE S 2,OOD,000
<br />CEO I X1 RETENTION S 0
<br />S
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YM
<br />ECUTIVE
<br />ANY OFFICERIMEMBER EXCLUDED?
<br />(Mandatoryin NH)
<br />If yea, describe timer
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />92427714018
<br />10/30/2018
<br />10/3012019
<br />X SiATUtE ERH
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE S 1,000,000
<br />EL. DISEASE, POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACDRD 101,Addi6ona1 Remarks Salwome% may ea attadeed Bmom spats is ra drad)
<br />The City of Santa Ana, It's officers, employees, agents, and representative are induced as additional insured per the attached endorse a`��a�
<br />1CrC�r f `.
<br />LIle`�
<br />A
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 -4., (.k+++ 4
<br />Q 19882016 ACORD CORPORATION. All chants reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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