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>�. I DATE (MMJDDfYYYY)
<br />i`1 L. V
<br />c,.....-,. CERTIFICATE OF LIABILITY INSURANCE 4/27,2016
<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 INSU'RER(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 Kristin Raider
<br />NAME:
<br />Ambassador Group Inc. PH Ne,Extl; (480)776-6950 {aPcJAI,A9a),I4a0D776-6951
<br />7010 E Chauncey In ADDRIESS:kreider@ambassadorins.com,
<br />Ste 230 INSURER(S).AFFORDING COVERAGE NAIL #
<br />Phoenix AZ 85054 INSURER A:'Valley Forge Insurance_ Company 20508
<br />INSURED ."��"Tyy)P,.�.a*"",�,INSURER„B:Transportation Insurance Company _ 20494
<br />CART? METER SYSTEMS, INC. L lNSURERC:Employers Preferred Insurance
<br />7056 ARCHIBALiD AVE STE 102-453 INSURERD:
<br />CORONA CA 92880 INSURERF:
<br />COVERAGES CERTIFICATE NUMBER-16-17 Master 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
<br />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
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR ......... TYPE OF INSURANCE _ .ADDL StJBR. __.. ......... M011CY E' F
<br />LTR I D POLICY NUMBER MMdDDfYYYY
<br />....
<br />POLICY EXP LIMITS
<br />MMIDDlYYYY
<br />'.. COMMERCIAL. GENERAL LIABILITY :
<br />EACH OCCURRENCE ',.. $
<br />1,000,000
<br />A ;... _ CLAIMS -MADE _ '.. OCCUR '.....
<br />DAMAGE TO RENTED. .
<br />PREMISES Ea occurrence $
<br />4 ) _ ........
<br />300,000
<br />...._.... _..
<br />''. X '.. 4025961..553 5/1/2016
<br />5/1/2017 IVIED EXP (Any one parson) $
<br />10,000
<br />_
<br />PERSONAL &ADV INJURY $
<br />,$
<br />1,000,000
<br />GEN°LAGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE......
<br />2,00...0,000
<br />X POLICY' PRO
<br />JECT LOG
<br />PRODUCTS - CbMPlbPAGG $
<br />..$
<br />2,000,000
<br />OTHER:....
<br />: EPLtl
<br />1.0,000...
<br />AUTOMOBILE LIABILITY
<br />_...
<br />COMBINED SINGLE LIMIT $
<br />(Ea accident)
<br />1,000,000
<br />X._... ANY AUTO
<br />BODILY INJURY (Per person) $
<br />Ed
<br />ALL OWNED SCHEDULED 4025961505 5/1/2016
<br />AUTOS AUTOS
<br />5/1/2017 BODILY INJURY (Peraccodenl) $
<br />_..
<br />NON: -OWNED
<br />y`
<br />PROPERTY G,4.M,4GE
<br />PR
<br />.....
<br />MIRED AUTOS AUTOS
<br />acddent).....
<br />Uninsured motorst property $
<br />3,500
<br />''. UMBRELLA LIAR OCCUR
<br />EACH OCCURRENCE $
<br />_. ......
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE... $
<br />DED RETENTION$
<br />_.. $
<br />WORKERS COMPENSATION ;..
<br />ERH
<br />AND EMPLOYERS" LIABILITY Y ! N
<br />SPER
<br />TATUTE. I
<br />ANY PROPRIETOWPARTNER�EX.ECUTIVE
<br />E.L EACH ACCIDENT $
<br />1, 000, 000
<br />OFFICEWMEMBER EX.CLIJDED7 N f A
<br />_... -
<br />C (Mandatory in NHI E1G2097823-02 5/1/2016
<br />5/1./2017 E,L DISEASE - EA EMPLOYEE $
<br />1, 000, 000...
<br />If yes, describe under
<br />._
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) e
<br />Coverage subject to policy farms, terms and conditions.City of Santa Ana, i eAficers, age
<br />and,
<br />employees and representatives are included as additional insureds
<br />as re d by writte ontract.
<br />Insurance is primary 6 non-contributory.
<br />ILMq;As 12LW-lvIa;MAIII W—ll9L R4W IIL•1L"
<br />City of Santa Ana Parks, Recreation &
<br />Community Services Agency M-23
<br />20 Civic Center Plaza
<br />Santa. Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE. CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Kristin Reider/KRE
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />IN'S025 R7nsmn I
<br />
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