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SCOTFAZ-01 ROSEM
<br />14" vRaCERTIFICATE OF LIABILITY INSURANCE
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<br />DATDIYYYY)
<br />61412 6/4/2015
<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 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(les) 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 License # OE67768
<br />IDA Insurance Services
<br />4350 La Jolla Village Drive
<br />Suite 900
<br />CONTACT All Smith
<br />NAME:
<br />PHONE FA%
<br />A/c No Ext: (619) 574.6220 ac, No: (619) 574.6288
<br />EMAIL
<br />ADDRESS: AIi.Smith@ioausa.com
<br />San Diego, CA 92122
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC4
<br />INSURER A: RLI Insurance Company
<br />13056
<br />INSURED
<br />INSURER B: Continental Casualty Company
<br />20443
<br />INSURER C,
<br />NO CO. owned Autos
<br />Scott Fazekas & Associates, Inc.
<br />INSURER D:
<br />GENERAL AGGREGATE $ 2,000,000
<br />17777 Del Paso Drive
<br />Poway, CA 92064
<br />INSURER E:
<br />A
<br />INSURER F:
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />X AUTOS
<br />HIRED AUTOS AUTOS
<br />COVERAGES CERTIFICATE NUMBER: 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 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 />IN5R
<br />LTR
<br />TYPE OF INSURANCE
<br />IN D
<br />WVD
<br />POLICY NUMB ER
<br />POLICY EFF
<br />MMIDDYYYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />X OCCUR
<br />Cont Liab/Sev of Int
<br />X
<br />PS80003027
<br />"\
<br />�Jt(Fjf�p JJJ
<br />f 1V�
<br />1 o
<br />06105/2015
<br />06/05/2016
<br />EACH OCCURRENCE $ 1,000,55
<br />DAMAGE TO RENT
<br />PREMISES Ea occurrence $ 1,000,005
<br />SD
<br />X
<br />MED EXP (Any one person) $ 10,000
<br />X
<br />GEN'L
<br />NO CO. owned Autos
<br />PERSONAL& ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER'.
<br />POLICY � ECT El LOC
<br />OTHER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />PRODUCTS - COMPIOP AGO $ 2,000,000
<br />Deductible $ 0
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />X AUTOS
<br />HIRED AUTOS AUTOS
<br />PSBOD03027
<br />106/05/2015
<br />06/06/2016
<br />COMBINED
<br />tlED SINGLE LIMIT $ 1,000,006
<br />BODILY INJURY (Per person) $
<br />BODILY INJURMAG accidenq $
<br />X
<br />PRO PERTY DAMAGE $
<br />E
<br />Per accitlent
<br />_
<br />A
<br />X
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />C AIMS -MADE
<br />PSE0001119
<br />0610512015
<br />06/05/2016
<br />EACH OCCURRENCE $ 1,000,00
<br />AGGREGATE $ 1,000,000
<br />DED X RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNER/EXECUTIVE Y/❑N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory inNH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />PSW0001945
<br />0610512015106/05/2016
<br />X IPERIOTH-
<br />STATUTE ER
<br />-_
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />—
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />B
<br />B
<br />Prof Liab/Cams Made
<br />Ded.: $20k Per Claim
<br />MCH288362613
<br />MCH288352513
<br />06/05/2015
<br />06/05/2015
<br />06/05/2016
<br />06/0512016
<br />Per Claim 1,000,000
<br />Aggregate 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Re: All Operations
<br />City of Santa Ana, its officers, employees, volunteers, representatives and agents are Additional Insured's with respect to General Liability per the attached
<br />endorsement as required by written contract.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions..
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014/01)
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />20 Civic Center Plaza (M-20)
<br />_T_vIl ,/ (` ��
<br />�1
<br />Santa Ana, CA 92702
<br />V
<br />ACORD 25 (2014/01)
<br />@ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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