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PEC'SI;11.04 VPPGOSWAMI <br />ACR.JRt-/A CERTIFICATE OF LIABILITY INSURANCE <br />...- <br />DATE (MMIDDIYYYY) <br />1/712015 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF .INFORMATION ONLY AND CONFERS NO RIGHTS UPON THI ! CEIII','I IFICATE HOLDER, THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFf,1f1DED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU^ JG INEORER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed, If SU13R3AT3I4 IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this cert:ific: to TI not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER License # 0726293 <br />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.PH�NNe <br />505 N Brand Blvd Suite 600 <br />Glendale, CA 912113 <br />CONTACT <br />NAME: <br />Ext , 816 539.2300 _,y;Ic No : 618) 539.2301 <br />EMAIL <br />ADDRESS: <br />INSURER(S) AFFORDING COVET' %GE NAIC9 <br />INSURER A: Fidelity and Deposit Comp': ny cif Maryland 39306 <br />INSURED <br />INSURER B <br />INSURER C: <br />Special Service for Groups <br />EACH OCC IRRENOF $ <br />905 E. 6th SL <br />INSURER 0: <br />INSURER E : <br />Los Angeles, CA 90021 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: RFVlslul NUPRId CFL: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME. I ABOW: FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME IT WI'rFl RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE'/ I IS E.UIIJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />/LTR <br />TYPE OF INSURANCE <br />DOL <br />5 <br />POLICY NUMBER <br />PODCY EFF <br />M IDDIVYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCC IRRENOF $ <br />CLAIMS -MADE D OCCUR <br />A -5I MAG_E�T I R_E7I'E6 <br />PREMISES Ea ocn r once $ <br />MED EXP O nyonopnreon) $ <br />PERSONAI &ADV INJURY $ <br />GEHL AGGREGATE LIMIT APPLIES PER: <br />GENERAL GGREGITE $ <br />PRODUCT'-CONI_P/DP AGO $ <br />POLICY❑JRO- LOC <br />OTHER:$ <br />AUTOMOBILE LIABILITY <br />COMBINEC F1 Gl9LIMIT $ <br />Ea acade@ I <br />BODILY IN. JRY (Per Person) $ <br />ANY AUTO <br />- <br />BODILY IN. JRY(Per nccident) $ <br />sr PERT <br />Per moil' , AM)0—AGI I-- $ <br />PHIREDAUTOS <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NONOWNED <br />AUTOS <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCC IRREUCIII_ $ <br />AGGREGA E $ <br />EXCESS LIAR <br />CLAIMS MADE <br />DED RETENTION $ <br />WORKERS COMPENSATIONSTAT <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />$ <br />TE OOTW <br />ER <br />�'—' <br />E.L. EACII ,CODSiNI- $ <br />OFFICER/MEMBER EXCLUDED? ❑ <br />(Mandatof, in NH) <br />NA <br />E.L. DISEA E-EI,EAPLOYEE $ <br />E.L. DISEA :E_POLI:,Y LIMIT $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />A <br />Crime <br />CGP 001792818 <br />01/0112015 <br />01/01/2016 <br />Employc a Dinhonesty 1,000,000 <br />A <br />Crime <br />CCP 0017928 18 <br />01/0112015 <br />01/01/2016 <br />Forgery i,000,00C <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may he attached If more space Is required) Q <br />Evidence of Coverage <br />3�3 <br />City of Santa Ana <br />Santa Ana Workforce Investment Board <br />1000 E. Santa Ana Blvd., Suite 200 <br />Santa Ana, CA 92701 <br />ACORD 25 (2094101) <br />SHOULD ANY OF THE ABOVE DESCRIBE/: POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, VOTIGE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROV11 ONS. <br />AUTHORIZED REPRESENTATIVE <br />J16,"~'�i"ev <br />© 1988-2014 ACORD CORP )RA'FIIJN. All rights reserved, <br />The ACORD name and logo are registered marks of ACORD <br />000123 <br />