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ACC R"' CERTIFICATE CIF LIABILITY INSURANCE
<br />laa�
<br />_ _ATE ---
<br />DATE l n, uDDm
<br />1 01116/2014
<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 pollcy(los) must be endorsed. If SUBROGATION 1$ WAIVED, subject to
<br />the terns and condilfons Of the policy, Sonata policies may require an endorsement. Astatement on this cerll0cato does not confer rights to the
<br />certificate holder III IIDU of such endorsoment(B).
<br />PROOUGEH Phone: 626332.226E Fax. 626339 -9921
<br />BAKER ROMERO & ASSOCIATES INSURANCE BROKERS, INC.
<br />760 TERRADO PLAZA SUITE 238
<br />CONTACT Baker Romero a Associates Insurance Brokers,
<br />---- '
<br />-- ...
<br />Mu, u, (626) 332.2258 _ 828)- 339.9921
<br />A .. www,bakerfomero,com
<br />.
<br />ADD_,
<br />RESS „
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC H
<br />COVINA CA 91723
<br />INSUREdA : Great American Insurance Companies
<br />• '
<br />Agency DOH. OG227190
<br />.............._,...._...............____._
<br />INSURED
<br />ARTS ORANGE COUNTY
<br />INSURER
<br />I
<br />3730 S. SUSAN ST 4100
<br />SANTA ANA CA 92704
<br />INSURERC
<br />DAMAGE TO REWEO ” "'"
<br />PREMISISTEaoccure,va
<br />100,000
<br />MED. EXP(Anyone parson)
<br />$ 6,000
<br />INSURER e:
<br />INSURER
<br />INSURERF
<br />COVERAGES CERTIFICATE NUMBER! 11643 PIPWAIr113 MI IMRFR•
<br />THIS IS TOCERTIFY THATTHE POLICIES OFINSURANCE LISTED BELOWHAVE DEENISSUED TOTHEINSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION 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 />MEN
<br />J.TB_
<br />TYPE OF INSURANCE
<br />.— .._____.._.______
<br />ADDL
<br />INSD
<br />SUER
<br />-
<br />POLICY NUMBER
<br />PCLICY EFF
<br />mmo
<br />POLICYEXP
<br />_(MM!e
<br />LIh71T5
<br />A
<br />X
<br />COMME.RCfAL GENERAL LIABILITY
<br />CLNMS.MADE OCCUR
<br />- -
<br />PAC 226-17.64
<br />02101/14
<br />02/07/16
<br />EACH OCCURRENCE_
<br />$ 1,000,000
<br />-
<br />DAMAGE TO REWEO ” "'"
<br />PREMISISTEaoccure,va
<br />100,000
<br />MED. EXP(Anyone parson)
<br />$ 6,000
<br />PERSONAL a AOV INJURY
<br />3 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO. rr _
<br />POUCY❑JECT `...._ -] LOO
<br />GENERALAGGREGATE
<br />__..._..
<br />5 2,000,000
<br />—._.
<br />PRODUCTS- COMPlOP AGG
<br />_,...
<br />$ 2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PAC 226.17.64
<br />92/07/14
<br />02/97/16
<br />COMBINED SINGLELIMIT
<br />tEaacGeem)
<br />$ 1,000,996
<br />ANY AUTO
<br />D_
<br />ALL OWNE SCHEDULED
<br />AUTOS AUTOS
<br />HIRED AUTOS X NON OWNED
<br />AUTOS
<br />UMBRELLA URB OCCUR
<br />"SEES LMe CLAIMS -MADE
<br />y�/��`y Y�
<br />�TppO ED ..�
<br />r SEiJ
<br />- „ -,
<br />--°-
<br />BODILY INJURY (Per person)
<br />$ ..
<br />UOUILV INJURY (POrawidanb
<br />._,.�.. ._
<br />$ -.
<br />X
<br />....,....
<br />PROPERTY DAMAGE
<br />ceraa e,
<br />_.._
<br />EACH OCCURRENCE
<br />—AGGREGATE
<br />_
<br />S
<br />,...,..
<br />DEB RLTENTIONS
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />Yin
<br />ANY PnOFMBTORmXCLUDE E%ECUmE
<br />OFFICFRR.IEMBER EXCLUDED?
<br />IMaumwryln Nlp
<br />OEECRIPTION OF OPERATIONSOeIOw
<br />_._,._.
<br />PER OT1T'
<br />STATUTE ER
<br />N/A
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<br />A jSIS1Bn 1 C
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<br />Itv A1'(Gr
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<br />y
<br />EL. EACH ACCIDENT Is
<br />E.L. DISEASE- EAEMPLOYEE
<br />$
<br />E.L. DISEASE- POLICY LIMIT
<br />�—
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<br />DESCRIPTION OF OPERATIONS! LOCATIONS /VEHICLES (ACORD 101, Additional Romo,He Schedule, may be attached if morn apace Is requlraU)
<br />The City of Santa Ana, Its officers, employers, agents, and representative are named as additional Insured. With respect to claims arising :V
<br />out of the operations and uses performed by or no behalf of the named Ensured, suoh Insurance as Is afforded by this policy is primary
<br />and Is not additional to or contributing With any other insurance carried, by or for the benofit of the additional Insured.
<br />m.
<br />CERTIFICATE .HOLDER '- CANCELLATION
<br />City Of Santa Ana
<br />20 Civic Contor Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Santa Ana, CA 92701
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AURIDRIZEO REPRESENTATIVE
<br />Attention:
<br />"
<br />Lillian Romero Gomez
<br />AcvKV 25 (20 i4iv'I) V 1 UUB•ZU14 ACURU CURPORATION, All rights rOSorved.
<br />The ACORD name and logo are registered marks of ACORD
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