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<br />SCOTFAZ-01 ROSEM
<br />9_0"" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />TYPE OF INSURANCE
<br />012014VV)
<br />sr3orzola
<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 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 does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OE67768
<br />IDA Insurance Services -SD
<br />4350 La Jolla Village Drive, Suite 900
<br />San Diego, CA 92122
<br />g
<br />CONTACT Ali Smith _
<br />PHONE -"-
<br />ac N EE.o (619) 574-6220 _ Nal; (619) 574-6288
<br />E -MAIL -.-
<br />ADDRESS: AII.Smlth@ioausa.Com
<br />X
<br />INSURER(S) AFFORDING COVERAGE NAIC#
<br />INSURERA: RLI Insurance Company 13056
<br />06105/2014
<br />INSURED
<br />INSURER B: Continental Casualty Company
<br />'20443
<br />Scott Fazekas 8 Associates, Inc.
<br />INSURER C
<br />17777 Del Paso Drive
<br />Poway, CA 92064
<br />INSURER o
<br />--- -
<br />_INSURER E
<br />GENEMLAGGREGATE $ 2,000,00
<br />PRODUCTS-COMP/OPAGG $ 2,000,00
<br />- INSURER F:
<br />COVE rcrAGES CtHIIPICATE NUMBER: REVISION NUMBER•
<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 CONDTTTOR 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 />!LTB
<br />TYPE OF INSURANCE
<br />A
<br />RYA HOD E
<br />POLICY NUMBER
<br />MMI�DNYY
<br />MDDNYYY LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1XI OCCUR
<br />Contractual Llab.
<br />X No Co. Owned Autos
<br />X
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-20) ^
<br />PSB0003027
<br />06105/2014
<br />06105/2015
<br />EACH OCCURRENCE $ 1,000,00
<br />-DAMAGFro RENTED
<br />PREMISES (Ed occurrence) $ _ 1,000,00
<br />MED EXP (Any one person) $ 10,00
<br />PERSONAL S ADV INJURY $ 7,000,00
<br />NLAGGREGATE LIMIT APPLIES PER
<br />POLICY �EQ a LOC
<br />GENEMLAGGREGATE $ 2,000,00
<br />PRODUCTS-COMP/OPAGG $ 2,000,00
<br />OTHER'.
<br />Ded UCtlble $
<br />AUTOMOBILE UABILITY
<br />A ANY Auto
<br />03027
<br />06105/2014
<br />0 610 512 01 5
<br />COMBINED SINGLE LIMIT $ 1,000,00
<br />Ea accident
<br />BODILY INJURY(Per person) $
<br />--
<br />-- SCHEDULED
<br />ALL OWNED - l
<br />AUTOS '. AUTOS 'i
<br />— --- --
<br />BODILY INJURY (Per accidenp $
<br />X HIRED AUTOS X NON -OWNED
<br />— AUTOS
<br />PROPERTY DAMAGE
<br />Peraccitlerr) $
<br />X UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE $ 7,000,00
<br />A EXCESS LAID
<br />PSE0001119
<br />06/0512074
<br />06105!2015
<br />AGGREGATE S 1,000,00
<br />DEO X 1 RETENTION S 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />ANDEMPLOVERS'UABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICE RRaEMBER EXCLUDED' ❑
<br />N/A
<br />PSW0001945
<br />06!05!2014 06105M015
<br />PER OTH-
<br />X- _STATUTE -_- ER
<br />E. L . EACH ACCIDENT $ 1,000,00
<br />-- -._
<br />_.
<br />E . DISEASE -EA EMPLOYEE $ 1,000,00
<br />(Mandatory in NH)
<br />If year describe under
<br />DESCRIPTION or OPERATIONS braow
<br />EL DISEASE -POLICY LIMIT $ 1,000,00
<br />B
<br />Prof LiablClms Made
<br />MCH288352513
<br />06/0512014
<br />06105/2015 ,Per Claim 1,000,00
<br />B
<br />Ded.: $20k Per Claim
<br />MCH288352513
<br />0610512074
<br />06105/2015 ,Aggregate 1,000,00
<br />DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, AddlUonal Remarks Schedule, maybe aaached If more apace Is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, volunteers, representatives and agents are Additional Insured's with respell to General Liability per the attached
<br />endorsement as required by written contract
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium In accordance with the policy provisions..
<br />AP$' OVFD AS TO FORM
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />!J I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />RYA HOD E
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />A anl ity Attorney
<br />AUTHORIZED REPRESENTATIVE
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-20) ^
<br />--T— �
<br />Santa An; CA 92702
<br />ACORD 25 (2014101)
<br />C 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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