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ACC>R& 1771ATE (MM/1111YYVY)
<br />CERTIFICATE OF LIABILITY INSURANCE: 1 3/17/2015
<br />THIS CERTIFICATEIS 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 poficy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain poficies may reqUire an endorsement, A statement on this certificate does not confer rights to the
<br />certificate holder in fleu of such endorsernent(s),
<br />PRODUCER
<br />CONTACT
<br />NAME: Jerry Noyola
<br />Greyling Insurance Brokerage
<br />3780 Mansell Road
<br />PH9NE (770)552-42251 FAX
<br />I fAIC. W)t: (866) 550 -4082
<br />E-MAIL noola@raling.com
<br />ADDRESS: Terry ygy,
<br />INSURERIS) AFFORDING COVERAGE NAIL #
<br />Suite 370
<br />iNSURERA:National Union Fire Ins Co 19445
<br />Alpharetta (3A 30022
<br />INSURED
<br />-INSURERB:Travelers Pro2erty CasualLy 25674
<br />INSURER C
<br />Psomas
<br />INSURER D
<br />555 S. Flower Street
<br />INSURER E
<br />Suite 4300
<br />Los Angeles CA 90071
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER:15-16 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 'THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
<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 />INSTRR
<br />L
<br />TYPE OF INSURANCE
<br />ADDL
<br />1i
<br />SUER
<br />VVVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />— --J CLAIMS,NAADE Fxl OCCUR
<br />2047634
<br />4/1/2015
<br />4/1/2016
<br />-I 1 RENT[ IS
<br />DAMAGE 1PREMISES 'E cnce) $ 500,000
<br />MED EXP (Any one person) $ 25,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />X Contractual LLata.lity.
<br />GENERAL. AGGREGATE $ 2,000,000
<br />N'L AG ;,I GATE LIMITAPPLIES PER
<br />–1
<br />PRODUCTS - COMP/0P AGO $ 2,000,000
<br />nGE
<br />_] PRO
<br />POLICYE'IECT X LOC,
<br />$
<br />-F
<br />AUTOMOBILE LIABILITY
<br />M EDtSINGLE LIMIT
<br />��IN
<br />(CEO, d.n� $ 11000,000
<br />BODILY INJURY (Per person) $
<br />A
<br />A I ANY AUTO
<br />ALL OWNED SCHEDULED
<br />ALTOS AUTOS
<br />3814893
<br />4/l/2015
<br />4/1/2016
<br />BODILY INJURY (Pei accident) $
<br />NON -OWNED
<br />X HIRED AUTO S AUTOS OS
<br />PROPERTY DAMAGE
<br />_JE2Laccidentt $
<br />1 $
<br />UMBRELLA LIA's
<br />"
<br />— ---
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />FICLAIMS-MADE
<br />DED I I RETENJONIi
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />39901498 (ACS)
<br />4/1/2015
<br />4/l/2016
<br />XI—w7---, T—jG—TH-
<br />To 'i I I ER
<br />E.L. EACH ACCIDENT" $ 100 ,000
<br />�A
<br />CNY PRIROPRUMEMBE�EFOR/PEXARCTNERLUDED?IE)�EC,I,,Jr[VE'
<br />FFER
<br />(Ma"I Cdatory in NF1)
<br />N/A
<br />39901499 (CA)
<br />4/1/2015
<br />4/1/2016
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OIIERATIONS belcw
<br />E.L. DISEASE - POLICY LIMI I $ 1,000,000
<br />--
<br />DESCRIPTION OF OPERA"rIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additions Rcnnarks Schedule, if nv>re space is reqeajred)
<br />45AN020100. The City of Santa Ana, its officers, employees, agents, volunteers & representatives are
<br />named as Additional Ins-tareds with respects to General & Automob,'Lle Liability where required by written
<br />contract. The above referenced liability Policies are primary & non-contributory where required by
<br />written contract. Waiver of Subrogation applies to General Liability & Workers Compensation where
<br />required by written Contract.
<br />PEUNICE HEREDIA (PG 1 OF 7)
<br />SOMAS AGREEMET A-2008-219 R
<br />NEVIEWED BY: A
<br />SHOW.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, No-ICEWIU- BE DELIVERED IN
<br />Ci t, � of Santa Aria ACCORDANCE WITH THE POLCY PROVISIONS,
<br />A/
<br />Clark c)f the Ci ty Counc.-Ll AUTHORIZED REPRESENTA,riVE
<br />San
<br />20 Civic Center P ' Laza
<br />ta Ana, CA. 92702
<br />David Collings/,TEIRRY
<br />TGOFTET25 (2010105) 1988-2010 ACORD CORPORATION. All rights r�7
<br />,sTr7ed,
<br />INSOPS onmn,,, m The Arr)Pn n:ximc, %nen
<br />
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