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INTEHOU -01 _ MCHAN CERTIFICATE OF LIABILITY INSURANCE °AT2111201`11201 Y Y' 23 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 'CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). _ _ NAME: CONTACT PRODUCER NAME: _ Chapman FAX 1 626 405 -0585 p PHONE 1 626 405 -8031 (Al. Na: a Division of Arthur J. Gallagher & Co. e p Lo Ea)' ( ) -_ - __. - 1 ( �— Insurance Brokers of California, Inc. ADDRESS: PO BOX 5455 INSURER(S) AFFORDING COVERAGE NAIC p Pasadena, CA 91117 -0455 -- - -- -- INSURERA:Riverport Insurance Company 36684 INSURED INSURERS: New York Marine and General Insurance Company 16608 Interval House INSURER C -- P.O. Box 3356 INSURER D: Seal Beach, CA 90740 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN5R [ DL SU R POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _(MMIDDIWYY MMIDDIYYYY) GENERAL UABIUTY EACHOCCURRENCE $ 1,000,001 DAMAGET -------O-RENTED A X COMMERCIAL GENERAL LIABILITY X RIC0012481 10/112012 10/1/2013 PREMISES (Ea occurrence $ 100,001 Pro _- �GLAIMS -MADE nOCCUR MED EXP(Any cneponon) I$ 5,001 XNSAGGRE�GATT�E LIMIT AbP�PUE�S PER : APPR�vF'y/ �� PRODUCTSGCOMPIOPAGG $- 3000,00 POLICY SECT I. LOG _ _ _ -- - - - ^- - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ` RG Ea acddenU $ _ ANY AUTO , 5 V BODILY INJURY (Per person) $ ALL OWNED SCHEDULED LISA City Att roey BODILY INJURY (Per accident) $ AUTOS — AUTOS HIRED AUTOS AUTOS -0WNED 1 PROPERTY er acadentDAMAGE - $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00 A X EXCESS LIAB CLAIMS -MADE RELOO12482 10/1/2012 10/1/2013 AGGREGATE $ DED 1XI RETENTION$ _- _. Aggregate $ 2,000,00 WORKERS COMPENSATION X I WC LIMIT OER AND EMPLOYERS' LIABILITY TORY S ER B ANY PROPRIETORIPARTNERIEXECUTIVE F---] NIA X WC201300000946 211/2913 21112014 1.1 EACH AcaDENr $ 1,000,00 OFFICERIMEMBER EXCLUDED' (Mandatory In NH) - EL DISEASE - EA EMPLOYEL to - 1000,90 If yW, describe under 1 000,00 DESCRIPTION OF OPERATIONS below EL DISEASE - POLICY LIMIT $ • Employee Theft RIC0012481 1011/2012 101112013 Deductible: $1,000 200,00 • Forgery/Alteration RIC0012481 10/112012 10/1/2013 Deductible: $1,000 200,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Contract #A- 2012 -050. City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured with respect to the General Liability policy of the named insured per the attached CG 2026 endorsement. Such insurance is primary and non - contributory per the attached endorsement. Waiver of Subrogation for Workers Compensation policy applies in favor of certificate holder - endorsement to follow. CERTIFICATE HOLDER City of Santa Ana Administrative Services Division Attn: Frank Hernandez 20 Civic Center Plaza, M -25 Santa Ana, CA 92701 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0— ll �-�- -- © 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD