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<br />ACORO' CERTIFICATE OF LIABILITY INSURANCE
<br />D03/15/2019Y)
<br />03115/2019
<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 endorsement(s).
<br />PRODUCER CONTACT
<br />NAME:
<br />Henderson Brothers Inc Ext): (412) 261-1842 ! FAX No):(412) 261-4149
<br />IaCC,,NN
<br />920 Ft. Duquesne Blvd. ,
<br />Pittsburgh, PA 15222 ADDARESS, infohendersonbrothers.com
<br />INS_URER(S)AFFORDING COVERAGE NAICN
<br />INSURER A: Travelers Property 8 Casua_lty 25674
<br />INSURED INSURER B:St. Paul Fire & Marine
<br />A-.W9A
<br />24767_
<br />25615 _
<br />SBA Communications Corporation 1130 I INSURERC:The Charter Oak Fire Ins. Co.
<br />19682
<br />8051 Congress Ave. 4 ,;LW9-0,366INSURER D: Hartford Fire Insurance Company Payable
<br />Boca Raton, FL 33487 1
<br />1 INSURER E
<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 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 />INSR rypE OF INSURANCE ADDLSUBR'
<br />LTR IN D WVD
<br />POLICY NUMBER
<br />POLICVEFF
<br />MMIDOIYVVY
<br />POLICY EXP LIMITS
<br />NIWDD/YYYY
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 900,000
<br />CLAIMS -MADE X OCCUR X
<br />EXGL-474M8138
<br />03/1512019 03/1512020 DAMAGE TO RENTED ggp,ppp
<br />PREMISES fEa occurrence $
<br />X $100'000 SIR
<br />MED EXP An one erson
<br />I$-
<br />PERSONALBADVINJURY � 900,000
<br />GEN'LAGGREGATE UMITAPPUESPER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />POLICY X _ PEBT LOC
<br />li PRODUCTS-COMP/OPAGG $ 2,D00;600
<br />OTHER:
<br />$
<br />A AUTOMOBILE- LIABILITY
<br />_
<br />COMBINEDSINGLE LIMIT _��QQQ,QQQ
<br />Ee accident $
<br />X ANY AUTO CAP-474M814A
<br />03/15/2019 03/15/2020 BODILY INJURY Perperson) $
<br />OPMED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident $
<br />_
<br />HIRTEOS ONLY AUTOS ONEDV
<br />Parr acclRoen�AMAGE -$
<br />B X UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE $ 25,000,000
<br />EXCESS LIAB CLAIMS -MADE ZUP-15N37405
<br />03/15/2019 03/15/2020 AGGREGATE $ 26,000,000
<br />DED X I RETENTION$ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />X STATUTE OTRH-
<br />ANDEMPLOYERS'LIABRm IUB-4L099102
<br />YIN _
<br />03/1512019 03/15/2020 1,000,000
<br />CUTIVE
<br />NIA
<br />EL EACH ACCIDENT $
<br />gAgN�YPERIMEETOR(PARTNDED?
<br />(manEa%/MEn NHR EXCLUDED?
<br />rY )
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,000
<br />If yes antler
<br />r
<br />1
<br />1QQg QQQ
<br />Endscnbe
<br />DRIPTION OF OPERATIONS below
<br />E. L. DISEASE -POLICY LIMIT $
<br />A Worker's Comp UB-31-884966
<br />03/1512019 03/15/2020 Each Acc/Policy Lmt 1,000,000
<br />D Prof/Poll (100k SIR) 40 CPI HA6405
<br />03/1512019 03/15/2020 Claim/Agg 6,000,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES /ACORD I01, Additional Remarks Schedule, my be attached if more space is required) `1
<br />Re: CA40805-T-0, Site Name: Carl Thornton Park
<br />V
<br />1801 W. Segerstrom Ave., Santa Ana, CA 92704
<br />City of Santa Ana, its officers, employees, agents and representatives are included as additional insureds for the G'enoncontributory
<br />basis when requiretl by written contract.
<br />CS�� Wr!m
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Cityof Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Clerk of the Council
<br />20 Civic Center, Plaza (M-30), P.O. Box 1988
<br />Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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