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BLUER -2 <br />OP ID: GI <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE IMMIODIYYYYI <br />THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br />0312512014 <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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the polloy, 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 />Momentous Insurance Brokerage Phone: 818.933.2700 <br />6898 Sepulveda Blvd, Suite 850 Fax: 818.933.2701 <br />Van Nuys, CA 91411 <br />Gregg inboden q/_0`.o/ 2 _00a <br />CONTA <br />FNON; <br />T <br />Gre _qg inboden <br />�f <br />a Nd. Ea1, 818. 933. 2729__ _ I lac rvor 818. 933.2795 <br />e'p'o"a�$ ; inboden „mrnibi.com <br />@° <br />—INSURER IS) AFFORDING COVERAGE <br />NAIC q <br />o • �.l <br />INSURED Blueray Management <br />PO Box 12529 <br />INSUReRA :Philadelphia lnsuranceCom an <br />INSURER a; State Com ensation Ins. Fund <br />- <br />18058 <br />INSURER C; <br />Newport Beach, CA 92658 <br />INSURER D <br />INSURER E: <br />INSURER F: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED <br />RS ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH <br />THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO <br />ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />ILTR <br />TYPE CP INSURANCE <br />rm <br />Em <br />- POLICYNUMBER <br />POLICYEFF <br />MMIDDIYY <br />LI YEXP <br />MMIDD YYY <br />- <br />LIMITS <br />GENERAL <br />LIABILITY <br />EACH OCCURRENCE <br />$ 2,000,00 <br />A <br />X <br />COMMERCIAL GENERAL <br />AL'L1IABILITY <br />PHPK1147404 <br />03124/2014 <br />0312412016 <br />UaE IS j}a accurra 8 <br />R� <br />$ 100,00 <br />CLAIMS-MADE I ^ OCCUR <br />MED EXP(Any one person) <br />$ <br />PERSONAL A ACV INJURY <br />S 2,000,00 <br />GENERAL AGGREGATE <br />$ 4,000,00 <br />AGGREGATE <br />LIMIT APPLIES PER: <br />PROOUCI'B- COMPlOP AGO <br />S 4,000,00 <br />GENL. <br />POLICY <br />PRO LOO <br />S <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIM17 <br />S 1,000,00 <br />A <br />X <br />ANYAUTO <br />PHPK1147404 <br />031241201¢ <br />0312412016 <br />EDGILY INJURY (Par person) <br />S v <br />NED X SCHEDULED <br />BODILY INJ (Per acciden0 <br />�_ <br />-j - <br />AUTOS AU70S <br />AUTOS <br />X <br />HIREDAU705 NON -OWNED <br />AUTOS <br />DA <br />PRO ERTY -DAMAGE <br />$ <br />a adGdon <br />S <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAB <br />_ <br />CLAIMS -MACE <br />AGGREGATE <br />$ <br />DEC ETENTICN3 <br />S <br />WORKERS COMPENSATJC <br />AND EMPLOYERS' <br />X WC STATLL GTH' <br />B <br />LIABILITY YIN <br />aL EACH ACCIDENT <br />$ 1,0_00,00 <br />ANY PROPRIETORIPARTNEMEXECUTIVE <br />OPPICERIMEMBER EXCLUDED? <br />NIA <br />9054636.13 <br />06/01/2013 <br />06/01/2014 <br />(Mandatory In and <br />(Mae dpaariIn under <br />DESGrRIP CN OF OPERATIONS below <br />_ <br />E.L. DISEASE- EA EMPLOYEE <br />$ 1,00000 <br />RL. DISEASE - POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ( Attach ACORDIUI,Addltlaaxl Remarks asoadule,Irmaroapaoo lsrequVed) <br />Certificate holder is named as additional insured <br />per the attached +' <br />endorsements. Primary and non contributory endorsement attached..+ <br />City of Santa Ana <br />Parks, Recreation & Community <br />Services Agency <br />1825 W. Civic Center <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCOROANOE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />TH EDRE <br />/ �) o <br />ACORD CORPORATION. All rights <br />+�� �a (AY: V:U.) 1 no AUURU name and logo are registered marks of ACORD <br />