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A-.2013-193 OP ID: Z8
<br />DATE (MMIDD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />1012412014
<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 poficy()es) 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 />YAME,
<br />San Francisco P&C
<br />PHONE,
<br />Hays of California ins Service
<br />(Afc, No,, Ext): (ANC. No):
<br />1350 Bayshore Hwy, Suite 218
<br />E-MAIL
<br />ADDRESS:
<br />Burlingame, CA 94010
<br />PRODUCER ICLEI-2
<br />ID C.
<br />Kathy Moresco
<br />CUSTOMER
<br />INSURER(S) AFFORDING COVERAGE NAIL if
<br />INSURED ICLEI USA Iric
<br />INSURER A: Hartford Underwriters Ins Co 30104
<br />414 13th Avenue, Suite 400
<br />INsURr Federal Insurance Company 20281
<br />Oakland, CA 94607
<br />INSURER C: National Union Fire Ins. Co. 19445
<br />INSURER D
<br />INSURER E!
<br />-INSURER
<br />F °:
<br />COVERAGES CERTIFICATE NUMBER:
<br />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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES 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 />400 ADOL,S(JBR PdOdy EFf; -Pd0cY cxP
<br />LTR TYPE OF INSURANCE POLICY NUMBER LIMITS
<br />iMMIDDfYYYY .
<br />GENERAL LIABILITY EACH OCCURRENCE 11000,000
<br />DAMAO 3r, TO RtNTI50
<br />B X COMMERCIAL GENERAL. LIAR BLIT-Y 35893074 1112612013 11/2612014 PREMISrS tVa $ 1,000,000
<br />CLAIMS-MADE X OCCUR MED EXP (Any one 10,000
<br />PERSONAL & ADV INJURY $ 11000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PffC PRODUCTS - COMP/OP AGO $ 2,000,000
<br />X Poucy PRO, $
<br />JEQT LOC
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
<br />(Fa accident)
<br />B ANY AUTO �73549972 1112612013 1112612014 BODILY INJURY I (Per person) $
<br />X ALL OWNED AUTOS BODILY INJURY - (Per accicient),
<br />SCHEDULED AUTOS PROPERTY DAMAGE
<br />X HIRED AUTOS I (PERACCIDENT)
<br />X NON-OWNEDAUTOS $
<br />NO OWNED AUTOS $
<br />X UMBRELLALIAB X ocrkm _OCCURRENCE 2,000,000,
<br />EXCESS LIAB CLAIMS-MADE AGGREGATE 2X01000
<br />B 7983.82-51 1112612013 11/26/2014,
<br />DEDUCTIBLE
<br />RETERTfON $
<br />WORKERS COMPENSATION x WCSIATU- 0111 -
<br />TORY LlNmys R
<br />AND EMPLOYERS' LIABILITY Y �,N
<br />A ANY PROPRIETOWPARTNER/EXECUTIVE 57WECLX9368 11101/2013 1110112014 FL EA01-I ACCIDENT $ 1,000,000;
<br />OFFICER)MEMBER EXCLLIDE6? NIA
<br />(Mand,itory in NH) F 1, MSEASE - FA EMPLOYE1: S 1,000,000
<br />llns,dezc 2e under E,L. DISrASr - POLICY LIMIT $ 1,000,000
<br />Q - SCRIPT ON OF OPERA HUNS below
<br />C Errors & Ornissions 01-423-70-02 11/261.,.
<br />112612013 11/2612014 E & O 1,000,,000
<br />Ded. 10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101, Additionat Remarks Schedule, If more space Is requircd)
<br />Cer,tificate issued as Evidence of Liability insurance coverage for above
<br />Named Insured
<br />ICLE1 USA, INC� AGREEMENT# 2013-193
<br />REVIEWED BY: � EUNICE HEREDIA (pg. I of 2)
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana Public
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Works Agency
<br />P.O. Box 1988, M.21
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />fJc 1988-Z1UUV At;UKL) k;UKrukAviufN, All rignis reserveu.
<br />ACORD 25:(2009/09) The AGORD name and logo are registered marks of ACORD
<br />
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