As.... "R" DATE (MMIDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE DATE
<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(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
<br />NAME: Delgado
<br />Pearas & Associates Insurance Brokers PHONE Ext; (8_00) 578 8802 (AMINO,4818)4419-9321
<br />CA License #0814733 EMAIL wdelgadopomsassoe.com
<br />ADDRESS:
<br />5700 Canoga Ave. #400 �_____.___....._._.INSURER;s)AFPbRDINGCGVERA.GE..._ NAICid _.
<br />_......._ _ _ _... _ _.....
<br />Woodland Hills CA 911367 INSURERa The American Insurance Company 21857
<br />INSURED INSURERB;Technolocry Insurance Co. Inc
<br />MCCUNE & HARBER, LLP. INSURERC;Allied world Assurance
<br />515 S Figueroa St, Ste 11,00 INSURERI
<br />Lias Angeles CA 90071 1 INSURER F:
<br />COVERAGES CERTIFICATE NUMFIFR-CL166341664 RFVI.glnN NI IIIJI
<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 />INSR
<br />.LTR,
<br />LTR
<br />TYPE OF INSURANCE
<br />:ADDLSUBR......_...
<br />.-_-,.._,
<br />POLICY NUMBER.
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMfDDIYY
<br />— _........ ......_...._...._
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$, 2,000, 000
<br />A
<br />CLAIMS -MADE........ OCCUR
<br />DAMAGETORENTED __.
<br />PREMISES Eaaaavrrehce-.._...$
<br />_........... 1.00,000
<br />MED EXP (Any one person)
<br />$. 10,000
<br />. _
<br />AZC80884450
<br />4/1B/2016
<br />4/18/2017
<br />PERSONAL, & ADV INJURY
<br />$.. 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.;
<br />GENERAL AGGREGATE.
<br />$ 4,000,000
<br />X P'OUCY EI JECT (� LOC
<br />PRODUCTS.. COMP/OP AGG
<br />$ 4,000,000
<br />_.....
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBEED SINGLE LIMIT
<br />ga accidenO
<br />$... 2,000,000
<br />A
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY
<br />$
<br />ALL OWNED SCHEDULED
<br />_..__ AUTOS _ AUTOS
<br />AZC80884450
<br />4/1.8/2016
<br />4/18/2017
<br />ICON -OWNED
<br />X
<br />PROPERTY DAM,4GE
<br />$
<br />FIR ED AUTOSAUTOS..
<br />Per ar..idenkj _._._
<br />$
<br />UMBRELLA LIAB
<br />HOCCUR
<br />EACH OCCURRENCE
<br />'.., $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />'X '... STATUTE '..... °R"
<br />AND EMPLOYERS' LIABILITY Y I N
<br />�'
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />ANY PROPRIETORFPARTNERIEXECUTIVE '°
<br />B
<br />OFFICERJMEMBER EXCLUDED?
<br />(Mandatary in NH)
<br />N 1 A
<br />IITWC354,8429
<br />5/15/2016
<br />5/15/2417
<br />_
<br />E.LDISEASE- EAEMPLOYE
<br />$ 1 00p pop
<br />if yes, describe under
<br />__......_.,.......
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT I
<br />$ 1,000,000
<br />C
<br />Professional Liabililty
<br />0309-6325
<br />6/4/2016
<br />6/4/2017
<br />Fach Claim $1,000,000
<br />Ag re to $1,Opp,Opp
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 109, Additional Remarks Schedule, may be attached if more space is re mf�e ) . , '0
<br />Evidence of Insurance Only, 1 i��
<br />(,
<br />Sandra M. S INva"Ma"n
<br />senior Assistant City Attorney
<br />I4 -1I 111Wi1ILei a
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Attorney's Office ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Mail Strap -29 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701r"{
<br />Wendy Delgada/WDELGA,
<br />®1988-201 9 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 or inot)
<br />
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