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"'°'� <br />CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDIY'YYY) <br />.. <br />10/02/2015 <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 IN'SURANC'E 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(ios) 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 />--.. -..... <br />PRODUCER <br />Willis Insurance Services Of California, inc. <br />CONTACT <br />NAME„-.--. <br />c/o 26 Century Blvd <br />'PHONE ...... .....r.._ tl FAX .._-- --_. ............... <br />A1C. ot1-877-945-73,76 N,(AIC�oI°1-888.4G,7..-2.3_78 <br />... -. <br />P.O. Box 305191 <br />E-MAIL <br />Nashville, TN 3723051.91 <br />ADDRESS:, certific.ates[wrillis.com ,. <br />AFFORDING COVERAGE MAIC# <br />� -- <br />INSLf Redwood Eire and Casualty Insurance Com an..... <br />11673 <br />INSUREDSpecial Service for Groups <br />INSURERS: <br />905 E. 8th St <br />INSURER C: <br />Loa Angeles, CA. 90021 <br />..--.. ._......-.... _....._.. _.... <br />INSURER D <br />INSURER E <br />INSURER F: <br />COVERAGES <br />CERTIFICATE NUMBER 5411 1 8 8 9 8 <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 AF'FORD'ED 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 />....... .- <br />INSR <br />LTRTYPE OF INSURANCE <br />ADDL.SUBR. <br />POLICY I <br />POLICY NUMBER MMIDD1YYYY <br />[ POLICY EXP <br />Y(MMIDDIYYYYI, <br />--....... ....... -....- <br />LIMITS <br />COMMERCIAL GENERAL. LIABILITY <br />EACH OCCURRENCE <br />S <br />-_'.. <br />I I <br />. CLAIMS -MADE u'... OCCUR. <br />DAMAGE TErJ RENTED IT1..- <br />PREMISES IEa occurrence <br />S <br />MED EXP (Any one person) <br />S <br />PERSONAL. S ADV INJURY <br />.� S <br />GEN'LAGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />-'ECT <br />POLICY ➢PRO <br />LOC <br />HOTHER' <br />PRODUCTS - COMP/OP AGG <br />S <br />S <br />AUTOMOBILE, LIABILITY <br />COMBINED SINGLE LIMIT <br />S <br />. LEa accidenll <br />ANY AUTO <br />I <br />BODILY INJURY (Per person) <br />S <br />ALL OWNED SCHEDULED <br />BODILY INJURY <br />S <br />Auras AUTOS <br />(Per accident) <br />,NON -OWNED <br />PROPERTY DAMAGE. <br />...., <br />.,' HIR .EDAUTOS AUTOS <br />IPor.accidnt)-- ................... <br />UMBRELLA LIAS OCCUR <br />EACH OCCURRENCE <br />5 <br />EXCESS LIAB CLAIMS -MADE <br />AGGREGATE <br />S <br />DEI? RETENTIONS <br />S <br />WORKERS COMPENSATION <br />77TH- <br />AND EMPLOYERS' LIABILITY YIN <br />.......... <br />A <br />ANY PROPRIETORIPARTNER/EXECUTIVE. <br />E.L. EACH ACCIDENT <br />S 1,000, 000 <br />OFFICERIMEMBER.EXCLUDED7 N <br />NIA <br />SP&7C607784 <br />10/01/2015 <br />10/01/201.6 <br />...... <br />""'.'°�. <br />.--_ <br />(Mandatory In I <br />F.L DISEASE -EA EMPLOYEE <br />S 1,000, coo <br />If yes, describe under <br />___ .......... <br />DESCRIPTION OF OPERATIONS below <br />I <br />E.L. DISEASE -POLICY LIMIT <br />S 1.., 0,00, 000 <br />V' <br />DESCRIPTION OF OPERATIONS 1 LOCATION'S I VEHICLES (ACORD 101, Additional Remarks Schedule„ maybe attached If more space Is regWred) <br />P <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana, its officers <br />employees, agents, volunteers, and representatives <br />Santa Ana Workforce Investment Board <br />1000 E. Santa Ana Blvd., Suite 200 <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 />919'88-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SR 10:10316851, SA'TCH:Batch $a: 174614 <br />