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<br />°® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDNYYY)
<br />02/13/2014
<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 policy(ies) 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 CONTACT
<br />Willis of Illinois, Inc. NAME,.__- __- .,_._,_,_____.- _,___- .,_____ _
<br />c/o 26 Century Blvd. PHONE Extl 1_8]]- 945 -]3]B _ FqC ryo 1- 888 -46]- 23]8__
<br />P.O. Box 305191 E -MAIL
<br />ADDRESS: certificateeBwillis.com
<br />Nashville, IN 372305191 USA — - -- — ---- - - -I'—
<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 />INSURER A.
<br />Travel ere Indemnity Company of CT
<br />25682
<br />INSURED evcknam -In_ fraest.r.uc_t—uz_e _
<br />Gz- o-u P Inc. - - --
<br />INSURERB:
<br />II
<br />Travalere Property Casualty Company of Americ _
<br />256]9
<br />3548 Seagate Way, Suite
<br />230
<br />INSURER C.
<br />Continental Casualty Company
<br />20443
<br />Dceanaitle, CA 92056
<br />MED EXP (Any one person) $ 5 000
<br />_
<br />Y
<br />6806A55628A
<br />INSURER D:
<br />09/16/2019
<br />_
<br />INSURER E:
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />INSURER F:
<br />PRODUCTS - COMPIOP AGO I$ 2,000,000
<br />COVERAGES
<br />CERTIFICATE NUMBER: W209859
<br />REVISION NUMBER:
<br />$
<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 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 />SUBRJ POLICY BEE POLICY EXP LIMITS
<br />ADDL POLICY NUMBER MMODIYYYY MM)D Y
<br />INSR TYPE OFINSURANCE
<br />LTR
<br />GENERAL UABILITY
<br />AUTHORIZED REPRESENTATIVE
<br />The City of Santa Ana
<br />EACH OCCURRENCE $ 1, 000, 000
<br />X COMMERCIAL GENERAL LIABILITY CITY
<br />XVTIMy+M�VP, us'---
<br />santa Ana, CA 92701
<br />DAMAGETORENTED 00 000
<br />PREMISES _(Ed occurrence) $ 1 0
<br />A J CLAIMS MADE [ X OCCUR
<br />MED EXP (Any one person) $ 5 000
<br />_
<br />Y
<br />6806A55628A
<br />09/16/2013
<br />09/16/2019
<br />PERSONAL BADV INJURY $ 11000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMPIOP AGO I$ 2,000,000
<br />POLICY I X PRO 0 OC
<br />IFCT
<br />$
<br />I AUTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT 1, 000, 000
<br />(Ea, accident)_ _ 8
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />A
<br />ALL OWNED SCHEDULED
<br />6506A55626A
<br />09/16/2013
<br />09/16/2014
<br />BODILY INJURY (Per accdent) $
<br />AUTOS AUTOS
<br />- T
<br />_ _
<br />NON OWNED
<br />X X
<br />PROPERTY DAMAGE $
<br />HIRED AUTOS AUTOS
<br />Teracndent) _
<br />CSL incl in GL$
<br />UMBRELLA LIAB OCCUR
<br />EACH OCCURRENCE $
<br />EXCESS LIAB CLAIMS -MADE
<br />AGGREGATE $
<br />DEC RETENtION$
<br />$
<br />WORKERS COMPENSATION
<br />X' WC STATU- OTH -
<br />LIMI_TS. ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />_�� l
<br />B
<br />ANY PROPRIETOR'PARTNERIEXECUTIVE
<br />E.L. EACH ACCIDENT $ 11000,000
<br />OFFICERIMEMBER EXCLUDEDP A
<br />NIA
<br />UB379DT99A
<br />09/16/2013
<br />09/16/2014
<br />(Mandatory In NH)
<br />EL. DISEASE - EA EMPLOYEE$ 1000,000
<br />If yes describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E L. DISEASE POLICY LIMIT I S 1,000,000
<br />C
<br />Professional Liability
<br />MCHZBS359767
<br />09/16/2013
<br />09/16/2014
<br />$1,000,000 Per Claim
<br />i
<br />$1,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aeacb ACORD 101, Addltianal Remarks Schedule, if more space Ia required)
<br />The City of Santa Ana, its officers, employers, agents, volunteers and representatives are included as Additional Insured as respects to General
<br />Liability. %n//
<br />l 1Z1Yt
<br />A� VO
<br />(15..
<br />unr nco 2 c• - Qtllk ti - reur•cl l ATlnu
<br />AgSlStall t CtV
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />The City of Santa Ana
<br />,1
<br />20 Civic Canter Plaza M -36
<br />XVTIMy+M�VP, us'---
<br />santa Ana, CA 92701
<br />V TJOO -LULU AL UKU L:UKVL)" I IVN. An ngn15 reserveD.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />SR rD:2856954 BATCH:eatch k: 28937
<br />
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