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In i <br />CERTIFICATE LIABILITY INSURANCE DA02/19/2015R <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(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 lieu of such endorsement(s). <br />PRODUCER ICONTANAME ERIKA STEWART <br />TERRY BRADSHAW, <br />SANTIAGOStateFarm 17871 BLVD., SUITE 207 <br />_*1 VILLA PARK, CA •.. <br />Q <br />INSURED <br />r <br />a%. - i y. <br />a a <br />CERTIFICATE NUMBER: <br />PHC,xFAX <br />NE ,714-637-4120 fAIC Ne.714-637-4260 <br />MAIL s. ERIKA.STEWART.T280(&STATEFARM.COM <br />L'AIL <br />B: <br />INSURER D <br />INSURER(S) AFFORDING COVERAGE I MAIC 4 <br />Farm Fire and Casualty Company 1 25143 <br />FrATiLqr*71Tff YnTFIETETR <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 />INSR <br />LTR <br />-.,_ "-'�"�" <br />TYPE OF INSURANCE <br />IttIOL <br />INSO <br />SUB R <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />(MMIDDNYYYI <br />POLICY EXP <br />JMMLQROrrm <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE LnI OCCUR <br />PREMISES Ea oodurcenca <br />S 300,000 <br />MED EXP (Any one person) <br />S <br />92 -CZ -W382.6 <br />OW1612014 <br />05/1612015 <br />PERSONAL & ADV INJURY <br />�v5,000 <br />$ 1,000,004 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />% POLICY E JED LCC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />PRODUCTS, COMP/OP AGG <br />$ 2,000,040 <br />$ <br />_ OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea aidenfl <br />$ ' 000 000 <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />471 7092-E19-75 <br />11/1912014 <br />05/1912015 <br />Ix <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BOOILYINJURY(Peracctdert) <br />$ <br />x NOWOWNED <br />HIRED AUTOS AUTOS <br />---.. <br />PROPERTY DAMAGE <br />(_AsraccddantL^_�.,- <br />-----._�..._.._.-..._....__.-....__ <br />$ <br />$ <br />C <br />X <br />OMBRELLa Llae X <br />OCCUR <br />N <br />92 -CZ -W386-5 <br />05/16/2014 <br />05/1612015 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y 1 N <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />ENIA <br />ER TH- <br />...., STATUTE ER <br />E T_ EACH ACCI DFNT <br />$ <br />E.L. DISEASE - EA EMPLOYE' <br />$ <br />E.L. DISEASE- POLICY LIMIT <br />- —""- <br />$ <br />DESCRIPTION OF OPERATIONS J LOCATIONS 1 VEHICLES (ACORD 101, Addidonal Remarks Schedule, may he attached It more speae I$ requimd) <br />GL ADDITIONAL INSURED AND PRIMARY AND NON-CONTRIBUTORY WORDING APPLIES PER THE STFESP101 ECW0910 ATTACHED AS REQUIRED <br />BY WRITTEN CONTRACT. RE: OPERATIONS OF THE NAMED INSURED, ADDITIONAL INSURED(S): CITY OF SANTA ANA, IT'S OFFICERS, AGENTS, <br />VOLUNTEERS AND EMPLOYEES, <br />AGREEMENT NUMBERS: A-2006-046 & A-2014-035 HENNE SSEY & F°j .NN:`,ws Ei.' _(..C: AG -R# A-2006-046 & A-2014-035 <br />REVIEWED BY; �'r ,� ..m" EUNICE HERE. IA (PG. 1 of 5) <br />CITY OF <br />PUBLIC WORKS <br />SANTA ANA, CA 92702 <br />SHOULD ANY OF THE ABOVE DESCRIBED ..O 5.. CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISION$, <br />aAUORIZEII "REPRESE1 TATIVE <br />L, A <br />,i PTAINI&F. F;"• +--.#�,, <br />•r <br />