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LIBCRA-4 OP ID: CA
<br />A1 C-74SOR"'
<br />V CERTIFICATE OF LIABILITY INSURANCE
<br />DATE `MMIDDIYYYY)
<br />07113r20116
<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(los) 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 an this certificate does not confer rights to the
<br />certificate holder In lieu of such endorsement a .
<br />PRODUCER
<br />Keller Stonebraker Ina. (HO)
<br />1120 C Professional Court
<br />P.O, Box 609
<br />Hagerstown, MD 21741.0609
<br />Jo n A. Latimer, IV
<br />nciarNTT cT John A. Latimer, IV
<br />PHONE FAX
<br />yc�Ne.E n 301-733-2630 _ _.Iac Ne.301-791A478
<br />E-MAIL
<br />AODRES5: _.
<br />INSURER s AFFORDING CrV�RAGE
<br />NAIC N
<br />."
<br />INSURERA:Great Northern insurance Col.
<br />20303
<br />INSURED The Library Corporation, r"\t ; ,'j L..,. _
<br />Carl Corporation and
<br />Tech -Logic Corporation, ETAL
<br />INSURER a , Federal Insurance Co.
<br />20281
<br />INSURERC:Chubb Indemnity
<br />-
<br />INSURER C :
<br />1 Research Park
<br />INSURER E :
<br />—
<br />Inwood, WV 25428-9733
<br />INSURER F r
<br />COVERAGES CERTIFICATE_ NUMBER! RFVIAI1t7M NII IMRFR•
<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 />CERTCFICATE 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 />NSR
<br />ILTR
<br />TYPE OF INSURANCE
<br />O L
<br />SUB
<br />POLICY NUMBER
<br />Y EFF _.,
<br />MMIOCCilYXYX
<br />POLICY
<br />MM1DDlYYXX
<br />_.
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-M OF % OCCUR
<br />X
<br />36031761
<br />05126I2016
<br />0612612017
<br />'
<br />EACH OCCURRENCE
<br />$ 1,000,00
<br />_
<br />PREMISES (e ogwre raj
<br />S i p(),00
<br />MED EXP (Any one Person)
<br />$ 10,000
<br />_
<br />_...._. _.....__..— m,m
<br />PERSONAL&AOVINJURY
<br />$ 1,000,00
<br />GFN'L
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY T JECTPQ_ LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,00
<br />PRODUCTS COMPlOPAGO
<br />$ 2,000,000
<br />$ _
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />DM8INEO 51NGLE LIMIT
<br />Eaaccldant
<br />$ 1,000,000
<br />A
<br />X
<br />ANYAI.ITJ
<br />736889135
<br />OW2612016
<br />061 612017
<br />BODILY GNJURY (Per Parton)
<br />a
<br />x
<br />ALLQWNEO SCHEDULED
<br />AUTOS FAUTOS
<br />NOWOWNED
<br />HfftFOAUTQs AUTOS
<br /><3QOILY'dN9URY(Paraccldent)
<br />PROPEFtTXDAAIAGE
<br />Pan dent
<br />$
<br />X
<br />UMBRELLALIAEI
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$.... 6,000,00
<br />AGORWATE
<br />$ 6,000,00
<br />B
<br />EXCESSLIA13
<br />CLAIMS -MADE
<br />79898662
<br />05/2612016
<br />06/2612017
<br />DEO I X RC"TE.RVONS 0
<br />C
<br />RKERS COMPENSATION
<br />AND EMPLOYERS' LIABIL IN
<br />AN -E ECu IUE X[
<br />ANFICPFROPN T Eft EXCLUDE
<br />(Mandatory In NH) i-1
<br />If yyes deacrihe under
<br />DCS RIPTION OF OPERATIONS below
<br />NIA
<br />71761556 (CA INCLUDED)
<br />0612812016
<br />0572612017
<br />X PT6ISll E R H.
<br />- - -
<br />.....
<br />E L EACH ACCIDENT
<br />E,LE
<br />DISEASE ^ EA EMPLOYE:
<br />"--'"
<br />$ 1,000,00
<br />.�. _....1,000,00
<br />6,.
<br />E.L. DISEASE -POLICY LIMIT
<br />-
<br />$ 1,000,00
<br />Professional Llab
<br />36031'761
<br />05126/2016
<br />05126/2017
<br />ClallmAgg 5,000,00
<br />Claims Made
<br />Retention 25,010
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACCRO 101, Additional Remarks Schedule, maybe attached Vf mwra apace Is required)
<br />City of Santa Ana, IV's Officers, employees, a tints, volunteers and A"
<br />representatives are additional insuretf as Ind�cated, when required by ��
<br />written contract per attached form 80-02.2367.
<br />Coverage is primary, non-contributory. tiN
<br />4\�
<br />CERTIFICATE HOLDER
<br />CAhICFLI_ATION + e,r - r- DO �,
<br />SANTAAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE -
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana
<br />ACCORDANCE WITH THE: POLICY PROVISIONS,
<br />20 Civic Center Plaza M-30
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />1980-2014 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2014101) The ACORD name and loge are registered marks of ACORD
<br />
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