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Client#: 1177321 <br />SIGNATEC3 <br />ACORD.. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIODIYYYY) <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />12/31/2014 <br />THIS CERTIFICATE IS ISSUED ASA 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(les) 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 <br />CONTACT <br />NAME: Toni King <br />USI Insurance Sery LLC -WG SCL <br />PA/CNNoExt:48O.888.0966 Arc, Na: <br />301 W. Warner Rd Suite 113 <br />E-MAIL toni.kin usi.biz <br />ADDRESS: g@ <br />Tempe, 85284 <br />01101/201C <br />480 351-4438 <br />44 <br />INSURER(S) AFFORDING COVERAGE NAICtl <br />INSURER A: Massachusetts Bay Insurance Com 22306 <br />INSURED <br />INSURER B: Underwriters at Lloyds London 15792 <br />Signature Technology Group <br />INSURER 0: Federal Insurance Company 20281 <br />DAMAGETORENTED <br />PREMISES Ea occurrence $399999 <br />INSURER D: Chubb Group of Insurance Compan 41386 <br />2424 ni Desert Cove Ave <br />an <br />Twin Cit Fire Insurance Com an 29459 <br />INSURER E: y Comp <br />AZ 85029 <br />INSURER FAlimerica Financial Benefit 41840 <br />COVERAGES CERTIFICATE 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 CONDITION OF ANY CONTRACTOR 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 />ADDLSUBR <br />INSR <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />OD4941575903 <br />D1/01/2015 <br />01101/201C <br />EACHOCCURRENCE $1009000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE _,�J OCCUR <br />DAMAGETORENTED <br />PREMISES Ea occurrence $399999 <br />MED EXP (Any one peraan) s5,000 <br />PERSONAL a ADV INJURY $1 000,000 <br />GENERAL AGGREGATE $2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />X POLICY JECT LOC <br />$ <br />F <br />AUTOMOBILE <br />LIABILITY <br />AW4941575703 <br />01/01/2015 <br />01101/201C <br />COMBcl COMBINEDSINGLELIMIT $1,909,009 <br />BODILY INJURY (Per person) $ <br />X <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BOOILV INJURY Per accident $ <br />( I <br />_ <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />If <br />A <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />OD4941575903 <br />01/01/2015 <br />01101/201E <br />EACH OCCURRENCE $5,000,000 <br />AGGREGATE $5,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED X RETENTION $5000 <br />$ <br />WORKERS COMPENSATION <br />WC STATU- OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTPIERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED9 <br />NIA <br />It E <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTIONOFOPERATIONShslnW <br />EL.DISEASE-POLICYLIMIT $ <br />B <br />Professional <br />UCS260146815 <br />01/01/2015 <br />1/01/2016 <br />5,000,000 <br />C <br />Crime <br />82260585 <br />10/29/201410/29/201 <br />1,000,000 <br />D <br />Emp Practice <br />1 <br />82409000 <br />07/01/2014 <br />07/01/201 <br />1,000,000 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is n.q.Ir.d) <br />City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives are additional insured for general liability per 391-1006 <br />06/09. Coverage is primary & non-contributory per 391-1331 06/09. Waiver <br />of Subrogation applies to general liability per BP0497. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />Attn: Lynda Kelly <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 />20 Civic Center Plaza M-12 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />© 1988-2010 ACORD CORPORATION. All rights reseryd. <br />ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD <br />#S14062748/M14059956 G TXKJB <br />o � <br />