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KUMAN-5 <br />li}O,.jp&, <br />DATE IMMIDDNYYYI <br />w�a �•-.,,,..:'^^"�"w��t" f <br />CERTIFICATE OF LIABILITY INSURANCE <br />09/2612019 <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(SI, 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, certaln 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 - 949-366.5104 <br />ACT Patricia Anderson ' <br />Brakke•Schafnitz Ins. Brokers <br />-MRI <br />ONE 949.366 6104 - Fnx 849 313 3266 <br />License #OK07568 <br />ac, No, E.I .... JAc � . _ ... <br />18 <br />28202 Cabot Road, Suite 600 <br />t1�ii 8.s rso 8 Al <br />Laguna Niguel, CA 92677.1261"-�--'— <br />.' ry <br />�IfiSULt�S1�1L1EF3�ItLGyoyg„R�,Jr�,.....- <br />- m. _____„�____,-,_,_• _.,_., <br />IrLsug&A;Guida0ne Mutual <br />INSURED Catholic Chortles of Orange <br />,INsygFEa;�__ _._.,,,__,-•_..,,•,„,• _„-, <br />_ <br />County <br />1820 E 18th Street <br />Santa Ana, CA 92701 <br />.JtLsvB.€89'. <br />INSURER F I. <br />. <br />PnVtCIAP rc! C00TWIPAT= MI 111MCICO, oC%1IQI^M MI. IftAM tl. <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 />SR <br />TYPE OF INSURANCE <br />0.EDL <br />91JE <br />_ - - "POCICV <br />POLICY NUMBER <br />EPP <br />POLICY EXP <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />_ <br />-,):ACH <br />OCCURRENC_F__,_,,, <br />#: ,•- .w <br />CLAIMS -MADE 171 OCCUR <br />EMIStzirO RENTED <br />F.MLaCS(Eaar <br />_, <br />.kLMSONAL A ADVJNHI.€.. <br />...— <br />LPL <br />AOORCOALIMIT APPLIES PER: <br />CtENS ML69(`REG& „W, <br />POLIi;N� TJEL'T klLOC <br />PRDOUC,TS„T�C,OMPIOP AGGe;j_T� <br />__ <br />____^___ <br />OTHEjjA <br />AUTOMOBILE <br />LIABILITY <br />- <br />COMBINED SINGLE LIMIT <br />ANY AUTO <br />eOg,ILY INJURY (F�r pnr�_, <br />8 <br />OWNED SCHEDULED <br />- - <br />AfURTEOpS ONLY Auutto <br />d]OIy.Y INJURYLeJ�ccrMnlj <br />._- <br />Ep <br />AUTOS ONLY AUTOS ONNLY <br />TPuOr srEudun DAMAGE <br />UMBRELLA LIAR OCCUR <br />: <br />EXCESS LIAR CLAIMS -MADE <br />A <br />WORKERS COIryv�IPENSATION <br />AND EMPLOYERTUABI IV <br />X I <br />SIAT1II�.,. CR- <br />.__ <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />Y <br />10005295 <br />0710'112019 <br />07/01/2020 <br />EL-5AQ}AJ1C„QIDENT <br />- 1,000000 <br />��ppFICE IM M FggE%CWOEE9 <br />IManda%ryEln�ri' <br />NIA <br />_ <br />- <br />I <br />Il yyedescribe undor <br />DE.t, PI nPQATIgHow. <br />YF,__-9AYMP�LfJM <br />E,LQ15EASF,-PC14YIIMIT <br />II <br />a _.. <br />1,QOo,B9D <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADGRD 1d1, Addidonol Romarks Schotlule, may Le saacLed II more apace Is roquired) <br />Waiver of subrogation WC0403060484 Is Extended on behalf of City of Santa <br />Ana, Its officers, employees, agents and representatives <br />P.PDTIMIr:ATP WAI 11P Y (`.AMr`CI I ATInM <br />SANTAAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />'` ` t QQ ,T TT r�/� <br />Clt Of Santa Ana REVIEWED f it"I11[OVI <br />y 1 <br />�t'�THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />CORDANCE WITH THE POLICY PROVISIONS. <br />Risk Management Divisioi�y ('i I51C MANACIEMENT DIVISI <br />N_. <br />)N <br />20 Civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />p sT�1 rift <br />Santa Ana, CA 92702 CT 0 G 2019 <br />— <br />ACORD 25 (2016103) L' Ahf(` t �tt 'to {Istered m (D 198FACORDCORD CORPORATION. All rights reserved. <br />