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DESMO-1 OP ID: SG <br />—.ATE <br />CERTIFICATE OF LIABILITY INSURANCE <br />11/28/2016 Y} <br />11!28!2016 <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 pollcy(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 does not confer rights to the <br />certificate holder in lieu of such endorsements). <br />PRODUCER <br />John J. Matsock & Assoc. Inc. <br />1750 N Washington Street <br />Naperville, IL 60563 <br />Steven L. Monteith <br />CONTACT <br />NAME: Steven L. Monteith <br />_......- <br />AH] N Ext,630-505-7888` aC Na, <br />E-MAIL <br />ADDRESS;__, <br />INSURER(S) AFFORDING COVERAGE <br />Al. It <br />INSURER A: Travelers Prop Cas CO <br />F2574 <br />INSURED Donna Desmond Associates <br />INSURER B: of America <br />A <br />Phone #310-475-1114 <br />X <br />265 South Beverly Glen Blvd. <br />INSURER C: <br />12/01/2017 <br />DAMAGE TO RENTED -----.._... <br />PREMISES Ea occurrence $ 300,00 <br />MED EXP Ani ane person) $ 10,00 <br />Los Angeles, CA 90024 <br />INSURER D: <br />INSURER E: <br />680-18716605 <br />INSURER F: <br />PERSONAL & ADV INJURY $ 1,000,00 <br />COVERAGES CERTIFICATE NIIMRFR' PPV[Czlnm NI IMRr-0. <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 />TYPE OF INSURANCE <br />AI)OL <br />5 B <br />POLICY NUMBER <br />pOtICY EFF <br />MWDD/YYYY <br />—POLICY EXP <br />MMIDDIYYYY <br />'- <br />LIMITS <br />20 CIVIC CENTER PLAZA M-36, <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,000,00 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />_...._ <br />CLAIMS -MADE � OCCUR <br />X <br />680-16716606 <br />1210112016 <br />12/01/2017 <br />DAMAGE TO RENTED -----.._... <br />PREMISES Ea occurrence $ 300,00 <br />MED EXP Ani ane person) $ 10,00 <br />A <br />X Ind Contractors <br />680-18716605 <br />PERSONAL & ADV INJURY $ 1,000,00 <br />GENERAL AGGREGATE $ 2,00_0,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 2,000,000 <br />X POLICY PROJE,- LOC <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT 1 O00 ,000 <br />Ea acpLct ) $ <br />., _ <br />BODILY INJURY (Per person) $ <br />A <br />ANY AUTO <br />680-1 B716606 <br />12101/2016 <br />12/01/2017 <br />'X <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY Per accident $ <br />( ) <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />- <br />PROPERTY DAMAGE -� <br />ER ACCIDE T}_,__ <br />_ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS'LIABILITY Y / N <br />ANY PROPRIETOR/PARTNERIEXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />NIA <br />WC STATU-OTH- <br />T_Q U <br />_ <br />1 '-- <br />E.L. EACH ACCIDENT $ - <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory in NH) <br />Ifs, describe under <br />E.L. DISEASE - POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Property Section <br />680-1B716605 <br />12/01/2016 <br />12/01/2017 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) <br />ADDITIONAL INSURED WITH RESPECTS TO GENERAL LIABILITY: CITY OF <br />SANTA ANNA,ITS OFFICERS, EMPLOYEES, AGENTS, VOLUTEERS AND <br />REPRESENTATIVES//ADDITIONAL INSURED IS PRIMARY AND NON CONTRIBUTORY <br />AGREEMENT NUMBERS A-2011-070; A-2019-038 & A-2015-159//AS REQUIRED BY <br />WRITTEN CONTRACT, CERTIFICATES ARE SUBJECT TO ALL POLICY TERMS AND CONDITION <br />REVCEIPVELt F <br />LAY: Et.OI IICE IEFdEDIA (PGG OF ) <br />E <br />CFRT1FIr:ATP I-Ir1[ 111;0 <br />!1Ak1r%M1 i A"^&I V V e <br />SANTAAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />CITY OF SANTA ANA <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PUBLIC WORKS AGENCY <br />ATTN: JASON GABRIEL <br />AUTHORIZED REPRESENTATIVE <br />20 CIVIC CENTER PLAZA M-36, <br />SANTA ANNA, CA 92701 <br />ACORD 25 (2010/06) <br />U 1958-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />