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09122/2015 5 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 certlff tate holder Is an ADDITIONAL INSURIED, the pol'Icyi must be endorsed. If SUBROGATION IS WAIVED, suabjeGt to the terms and conditions of the policy,, certain policies may require an endorsement. A statement on this certificate does riot canter (rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Mercer Consumer Mercer Consumer, a service Of PHONE FAX Mercer Health & Benefits Administration LLC AAC ND EXt I' BQp.343 p13 AIC No): 515-2'82-8324 P.O. BOX 9277 E-MAIL Des Maines, IA 50306-9277 ADDRESS: CABar.servlce mercer.com INSURER S AFFORDING COVE OE NAIL INSURED INSURER A: Arch Insurance Company 111150 Donald H. Mayncr, 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 THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE. BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI10 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 HEREINIS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _... ... _.. m_m ._..___ _ _ . __ ._ _._... _._ SR,i ADD'L SUB�R POLICY EFIF POLICY EXP TR TYPE OF INSURANCE INSRD VVVD POLICY NUMBER IYYYYi IMMIDD/YYYY) LIMITS GENERAL. LIABILITY EACH OCCURRENCE ..m.._. ............... ........m__--_-_ Y?AB+>7id,GL rCaChJB COMMERCIAL GENERAL LIABILITY PREMISCS (Ea gs.currrr anrc) CLAIMS -MADE I � OCCUR MED EXP (Any one (person), $ .._....._._.__._ � PERSONAL & Ai INJURY GENERAL. AGGREGATE. ...._._ _...._._.__._......._...._ III _.._.._._.._.___.._......._......'. GEN"L AGGREGATE. LIMIT' APPLIES PER:PRODUC1 S...—GOMP/OP' AGO '', ._.........._.._................... __..._........... ..... ......_......m._......_.....__..._.._ ..... ..._....._............... ._...--------.-'.-- POLICY PRC- LOC i JIECT AUTOM013ILE LIABILITY 1 COMBINED SINGLE I..IMIT Ea accident _._._.__._...._,.._,. NY AUTO BODILY INJURY Per ersran._........_______.............. _...e.._._._........__ ALL OWNED AUTC7SSCHEDULED BODILY INJURY AUTOS Per accident HIRED AUTOS NON -O WNED AUTOS PROPERTY DAMAGER "' Per aeciden8 UMBRELLA LIAROCCUR EACHGCCLURPE.NCE .. EXCESS LIAn CLAIMS-MADEAGGREGATE 1 3 i DED I ETENT'ION 5 $ WORKERS COMPENSATION LNC _W U GT°Fi H- AND EMPLOYERS' LIABILITY lC1R�l I.IVIIeUTS _. _ER.— --------- ANY PROPRIETORIPARTNER/EXECUTIVE. YIN NSA I EACH ACCIDENT S If yes, describe under E.L DISEASE...... EA EMPLOYEE S DESCRIPTION OF OPERATIONS br:lcrw (Mandatary In NH) E.IL DISEASE — POLICY LIMOT $ �. OFFICERIMF_MBE,R EXCLUDED? OTHER-PROFESSIONIALLIABILITY INSURANCE_...._..._. 11LPL.0709912 0910112015 09101l201l6 LIMITS: PER CLAIM: $1,000,000 . A RETRO DATE: Full Prior Acts AGGREGATE: $1,000,000 DEDUCTIBLE 1'10,000 DESCi2 PTION OF OPERATIONS I LOCATIONS C VEHICLES (Attach ACORD 101, Additional Remarks .Schedule, If more space Is required) Evidence Of Insurance CERTIFICATE HOLDER CANCELLATION City of Santa Ana, It leers,. Employees,Volunteers,end SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHIE EXPIRATION DATE THEREOF, INOTICE'WhfILL BE DELIVERED Representatives INACCORDAiNCE WITH THE POLICY PROVISIONS, 20 Chic Center plaza i AUTHORIZED REPRESENTATIVE Santa Ana, CA 927112 pp a+ ACORD 25 (2010105) @1988-20110 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks off ACORD I 9' 9 �00 0 r