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SBACO -1 OP ID: NC
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<br />CERTIFICATE OF LIABILITY INSURANCE DATE(M9120YYY)
<br />�- 0310912f }16
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED„ the policy(ies) must be endorsed. If SUBROGATION IS 'WAIVED, subject to
<br />the terms and conditions of the policy, certain (policies may require an endorsement. A statement on this certificate rives not confer rights to the
<br />certificate holder in lieu of such andorsement(s).
<br />PRODUCER
<br />Henderson Brothers, Inc.
<br />920 Ft Duquesne Blvd
<br />Pittsbur�ggh, PA 1522.2
<br />Clem J.'Wandrisco, III
<br />INSURED
<br />Thomas Hunt, Esquire
<br />5900 NW Broken Sound Parkway
<br />Boca Raton, FL 33487
<br />Clem J. Wandrisco
<br />,& -4112-261-1842
<br />INSURER A ::Travelers Property Casualty Co
<br />INSURER B: St Paul Fire & Marine Ins Co
<br />INSURER 1Illiinois Union Insurance Compa
<br />r- rtlErmArJCC r1=0Tl1.117ATC fdIIURl =ra• PF:VIRIC)NI NIIRARr -P-
<br />412-2614149
<br />NAIL #
<br />25674
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTW'atTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER, DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR„ ,,..- TYPE OF INSURANCE IINSR 1 11.11 ., POLICY NUMBER .....,...... ....
<br />LTR
<br />_.
<br />.MIMk4?pF�YNEY WP1NIfp��YXYPY E .. . ..,. LIMITS
<br />-.....
<br />,....._.
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$
<br />900100
<br />A
<br />X COMMERCIAL GENERAL LIABILITY X TJE'XGL474IWI8138TI'.L16
<br />e' DAMAGE TO RENTED
<br />0311512015 03116/2016 PREMISES (Ea,g urranca)....
<br />900,00
<br />CLAIMS -MADE X OCCUR
<br />MED FXP (Anyone parson) w
<br />$
<br />.....,.,.. NIA
<br />,X $100,000 SIR
<br />PERSONAL & AOV INJURY
<br />900,00
<br />• f Ip
<br />GENERAL AGGREGATE I
<br />.. __
<br />GENL AGGREGATE LIMIT APPLIES PER: 9
<br />..._.
<br />I I PRODUCTS - CGMPIGP AGG
<br />$
<br />, 2,000,00
<br />00,00
<br />..._......
<br />!
<br />POLICY PRO• LOC
<br />JEQT
<br />I
<br />AUTOMOBILE LIABILITY
<br />!
<br />lTC2JCAP474M814ATIL15
<br />f COMBINED SINGLE LIMIT
<br />11000,0,0,
<br />A
<br />X ANY AUTO
<br />03115.12016 03M612016 BODILY INJURY (Per parson)
<br />�
<br />ALL OVVNED ! SCHEDULED
<br />AUl`OS AU "I OS
<br />X, HIRED AUTOS X AUTOS
<br />e
<br />� �
<br />BODILY INJURY (Pea accident)
<br />99' ...
<br />(PFRPAGCIDENT�AGE
<br />S
<br />_ .,'...
<br />_)
<br />X 100,0'CMO DED -HCPD
<br />_
<br />j( UMBRELLA LIAR
<br />Ii OCC ".UiC �
<br />EACH OCCURRENCE
<br />S
<br />25,000,00
<br />B
<br />EXCESS LIAR C:(AIMS "MADE
<br />OEO �i REl "EN "rIONS 10,000
<br />WORK0R19COMPENSATION
<br />ZUP16'N3740616NF
<br />0311612015 0311612016 AGGREGATE
<br />CWC STATU OTH
<br />WKY._LIM.11S Ell-
<br />s
<br />26,000,00
<br />A
<br />EMPLOYERS` LIABILITY
<br />;
<br />ANY PROPRIE.TOPJPARTNEFUEXECVTIVE r j NIA
<br />' OFFICERdMEMBEREXCLUDEO7 N
<br />TC2�lU84T5fVtaI37I116 AOS
<br />( )
<br />_
<br />0311612015 0311512016 E L. EACHACCIDENT
<br />.... ,.
<br />1,000,00
<br />_... ..,_.
<br />A
<br />(Mandafoey In NHI
<br />TRJUB476Il&I30A16
<br />0311612015 0311612016 E.L. DISEASE EA EMPLOYE
<br />_..,,.
<br />s _.
<br />1,000 000
<br />If Yea, describe uncle;
<br />DESCRIPTION OF OPERATIONS laakaw
<br />E.L, DISEASE - POLICY LIMIT
<br />S
<br />1,000,000
<br />C, PROFESSIONAL
<br />COOG24541800006
<br />03/1612015 0311612016
<br />CLAIMIAGG
<br />5,000,00
<br />POLLUTION
<br />w
<br />!SIR
<br />I
<br />100,00
<br />DESCRIPTION ER DS!VEHICLES A p Remarks actadu.I. space la required)
<br />Site Nunbe;C14589 OSiteName AdamrPa rkr 2302 w a.tt Santa Rn ®+ CA ,"', '�,/•Y
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<br />CA46897
<br />City of Santa Ana, Executive
<br />Director Parks, Rec and
<br />Community Serviced ('M -23)
<br />26 Civic Center Plaza, M -76
<br />Santa Ana, CA 92703
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />1988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2010105) The ACORN name and logo are registered marks of ACORD
<br />
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