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ACRO CERTIFICATE OF LIABILITY INSURANCE 9/Z^6TE2014Dlvvvvl 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. 20111 OCT 27Pi4 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statemenfh� Tys,C�ectif''F�tG � X n tl,Go,!�ter rights to the certificate holder in lieu of such endorsement(s). 4� I 1fV t f-i� iV FA PRODUCER CONACT NAME: Vy Sellier-F D 7111_ Wood Gutmann & Bogart PHONE — — rPAX -- - _-- License #0679263 _(AiNa,_Exq:.714-505-7000 (Alc Nop 714-573-1770 15901 Red Hill Ave., Suite 100 ADDR€SS, vy@wgbib.com _ Tustin CA 92780 INSURER{9J_AFFORDING COVERAGE NAIC k 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, INSURER A: Philadelphia Indemnity Ins Co. INSR ,TRI TYPE OF INSURANCE INSURED COAST06 POLICY NUMBER INSURER 8 POLICY EXP MMIDOIYYYY LIMITS Coast Live Oak School X COMMERCIAL GENERAL LIABILITY INSURER C: _ _ Mark Hay 9/22/2015 EACH OCCURRENCE - -� — CLAIMS -MADE Ll OCCUR 316 Edgewood Road INSURER D: _ _ $1.00000 Santa Ana CA 92706\� cCSILt GQ INSURER E INSURER F: PERSONAL&ADV INJURY OhVFRAnIPA OFRTIFICATF NIIMRFP- 1922668671 RFVI.RIr1N NIIMRFR- 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. INSR ,TRI TYPE OF INSURANCE ADDgSUa INSDWVD POLICY NUMBER POLICY EFF MMIOOIYYYY POLICY EXP MMIDOIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK1220574 /22/2014 9/22/2015 EACH OCCURRENCE $1000000 -� — CLAIMS -MADE Ll OCCUR _ DAMAGE TO RENTED PREMISES Ea occurrence _ $1.00000 -_ MED EXP(Any onepemon) $5,000 PERSONAL&ADV INJURY $1000000 - AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_''. GEL $2000000 _ POLICY JT EOT 1:1 LOCPRODUCTS-GOMP/OP AGG _ $2000000 OTHER' li $ AUTOMOBILE LIABILITY � „Q c� \¢ COMBINEDtSINGLE LIMIT 1 $ ANY AUTO f`O1/V ([...s.1L'A� S�111YW,nn D INJURY (Per person) $ AUTOS OWNED AUTOEDULED-, �� Y�'C BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS h I �ye C�1 PROPERTY DAMAGE (Per accident,_ --- - $ 5 UMBRELLA ,IAB OCCUR EACH OCCURRENCE _$ AGGREGATE EXCESS LIAB CLAIMS -MADE $ DED RETENTION $ _ $ WOR KERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- ER _. —_STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A - E, L. DISEASE -EA EMPLOYEE -- $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below - E L DISEASE - POLICY LIMIT '— - - S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana, its officers, agents and employees are named as additional insured on the General Liability per attached PI OLD VS 01 08. Cancellation verbiage as per IL0017 11 98 attached. Primary and Non -Contributory applies on the General Liability per attached PI GILD VS 01 08. THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED. CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana, Parks, Recreation and Community ACCORDANCE WITH THE POLICY PROVISIONS. Services Agency Attn: Carmen Acosta AUTHORIZED REPRESENTATIVE Civic Center Drive Sant A Santa Ana CA 92701 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD