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CERTIFICATE OF LIABILITY INSURANCE oATEIMMIDDnYYYI
<br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C08/07/2019
<br />ERTIFICATE 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 CONTRACT BETWEEN THE ISSUING INSURERJS), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollaypes) 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 lint] of snnh nndnrenmm.uc%
<br />PRODUCER
<br />Kelley Jiggins and Associates Insurance Brokers
<br />PO Box 60310
<br />Pasadena
<br />MDG Associates, Inc.
<br />10722 Arrow Route
<br />Suite 822
<br />CA 91116-6310
<br />CA 91730
<br />INDICATED.
<br />-'- ---'- ., •••.., ...,..,�., ..r
<br />NOTIMTHSTANDINGANV REQUIREMENT,
<br />,rvwnnrvuc
<br />TERM
<br />uo my nc n�vt Ji ISSUED
<br />OR CONDITION OF ANY CONTRACTOR
<br />TO THE INSURED
<br />OTHER
<br />NAMED ABOVE
<br />FOR THE POLICY PERIOD
<br />CERTIFICATE
<br />MAYBE ISSUED OR MAY PERTAIN,
<br />THE
<br />INSURANCE
<br />AFFORDED BY THE POLICIES
<br />DESCRIBED
<br />DOCUMENT
<br />HEREIN
<br />WITH RESPECT TO WHICH THIS
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES,
<br />LIMITS
<br />SHOWN MAY HAVE BEEN REDUCED
<br />BY PAID CLAIMS,
<br />IS SUBJECT
<br />TO ALL THE TERMS,
<br />MR
<br />LTR
<br />TYPE OF INSURANCE
<br />, SIC--
<br />POLICY NUMBER
<br />Pbl .Y
<br />(MM2MC 1
<br />MM/aD 'x
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />-
<br />EACH OCCURRENCE $ 1000,000
<br />GANAp1?723RERPED�'""'�
<br />PRk�j19ESJP� of•�M.g
<br />200,000
<br />CUSIMSMADE X OCCUR
<br />MEa EXP{Any oneperson)
<br />$ 15000
<br />A
<br />Y
<br />Y
<br />BKW57179298
<br />07/01/2019
<br />07/0112020
<br />-
<br />PERSONAL&ADV INJURY
<br />$ 1,000,000
<br />OeN'LACO-ACC TELIMITAPPLIESPER:
<br />fM1 POLICY JECT LOC
<br />GENERALAGOREGATE
<br />$ 2,000,000
<br />PRODUCTS-COMP/OPAGG
<br />$ 2,000,000
<br />S
<br />AUTOMOBILE LIABILITY
<br />OfaS
<br />�i.tlQO. t EI tT
<br />g 1,000 600
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident) -
<br />il
<br />.,.•®'.'.--....•••.........-
<br />$
<br />g
<br />oUT NAUTOSSCHEDLED
<br />AI OLY AUTOS
<br />Y
<br />Y
<br />8AS57179298
<br />07/01/2019
<br />07(0112020
<br />E
<br />f'+AVT030NLY X AUTO$ONLVNON-OWNED
<br />PER AM
<br />$
<br />-I?er aefldQpll
<br />$
<br />UMBRELLA LIAR X OCCUR
<br />- 4
<br />�"-
<br />C
<br />X ExcEs8 LIAB
<br />cLAIMs-MADE
<br />ESA57179298
<br />07l01/201D
<br />0>/01/2020
<br />EACHOCCURRENCE
<br />$ 4000, 000
<br />AGGREGATE
<br />$ 4,000,000
<br />DED RETENTION 5
<br />WORKERS COMPENSATION
<br />- - ""`^'
<br />---..
<br />AND EMPLOYERS' LIABILITY YIN
<br />_R O _--
<br />STATUTE ER:
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE
<br />OFFICER)MEMBEREXCLUDED? I I
<br />NIA
<br />[. EEACHACCIDENT -
<br />$
<br />IManderory In NHlIf
<br />yet, yen, desedbe under
<br />E,L.DISEAS -EA EMPLOYEE.
<br />DESCRIPTION OF OPERATIONS rest
<br />EL pISEASE-POLICY LIMIT
<br />DESCRIPTION OFOPERATIONSI LOCATIONS I VEHICLE?IACOR01a1r Adtlieonol RomarW schedule, moy be attachee if more apace lsmqulredl
<br />�� '�
<br />The City of Santa Ana, Its officers, employees, agents and volunteers and named additional insured, but only as respects the insured's
<br />operations as it
<br />relates to their signed contract In regards to the CDBG Administration Consluting Services per form CG8810 0413; Primary Insurance Transfer
<br />or recovery against others is included in the form,
<br />and of rights
<br />'30days Notice of Cancellallon except 10 days for non-payment,
<br />REVIEWED & APPROVED
<br />By Risk MANAGEMENT DIVISION
<br />GERTIFICA' c, HOLDER
<br />CANCELLATION
<br />D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />VILLA
<br />City Of Santa Ana, Risk parinniern ( -
<br />EXPIRATION DATE THEREOF,
<br />t�'R��LB;
<br />A�COROANCE
<br />NOTICE WILL BE DELIVERED IN
<br />Management D
<br />WITH THE POLICY
<br />PROVISIONS.
<br />20 CIVIC Center Plai 4TH FI
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702
<br />-All rig r,,,mod.
<br />©i986-2015 ACORD CORPORATION. rights reserved.
<br />ACORO 25 (2016l03) The ACORD name and logo are registered marks of ACORD
<br />
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