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T a ,"t I', 1,/ I dmµ A C"RL> 1212412014 -- CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such end'orsement(s). PRODUCER CONTACT POLICY EXP MWDD/YYYY NAME: Rene Hetzer Mercer Consumer, a Service Of Mercer Health & Benefits Administration LLC PHONE (AIC, No, Ext): 866-795-4154 Ext 52915 FAX {AIC, 1 515.365-0657 E-MAIL P.O. BOX 9277 Des.. Moines., IA 50306-9277 ADDRESS: Rene. hetzer@mercer.com.. EACH OCCURRENCE $, DAMAGE 70 PREMISES (Ea. ncTE,1,1 cel $ INSURERS AFFORDING COVERAGE N'AIC # INSURED INSURER A: Arch Insurance Company 11150 Donald H. Maynor, APLC INSURER B: 235 Catalpa Drive Atherton, CA 94027 INSURER C: INSURER D: INSURER E: INSURER F:. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR. CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TR TYPE OF INSURANCE. ADD'ADD'L INSRD SUER WVD POLICY NUMBER POLICY EFF MM1DDf YYYY POLICY EXP MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $, DAMAGE 70 PREMISES (Ea. ncTE,1,1 cel $ COMMERCIAL GENERAL. LIABILITY' MED EXP (Any one person) CLAIMS -MADE F-1 OCCUR u '... PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS _ COMPIOP AGG $ $. POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident! BODILY INJURY $ Per I ANY AUTO BODILY INJURY Per acdclent $ A ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNIED AUTOS PROPERTY OAMAGER Per accident 'UMBRELLA LAB OCCUR EACH OCCURRENCE S. ''., AGGREGATE $ EXCESS LIAR CLAIMS -MADE S ED I IRETENTION $ WORKERS COMPENSATION WC STATU- OTH:- AND EMPLOYERS" LIABILITY TORY LIMITS E^ „__... E.L EACH ACCIDENT S ANY PROPRIETOR/PARTNERlEXECUTIVE YIN NIA E.L DISEASE - EA EMPLOYEE S � .....�� If yes, describe underI� DESCRIPTION OF OPERATIONS below u E.L DISEASE - POLICY LIMIT S (Mandatory in NH) OFFCGERJMEMBER EXCLUDED? OTHER • PROFESSIONAL LIABILITY INSURANCE 11LPL07D9911 0910112014 09/0112015 LIMITS: PER CLAIM: $1,000,000 A RETRO DATE: Full Prl or Acts AGGREGATE: $1,000,000 DEDUCTIBLE: $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 181, Additional Remarks Schedule, if more space is required) Claims Made CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED City of Santa. Ana T INACCORDANCE WITH', THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, ICA 92702 � "'APPR(I", The ACORD name and logo are registered marks of ACORD