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CERTIFICATE OF LIABILITY INSURANJ <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 polley(les) must be andarsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain pollcles may require an endorsomenL A statement on this certificate does not Confer rights to the <br />PRODUCER CONTACT Tanli Etahever / <br />NAME: v <br />Brakke-Schafnitt ins, Brokers <br />License #9428915 PHCxE3 <br />tw g4S 65.5159 twe 0 <br />I 28202 Cabot Road, Snits 600 , E, A`Lm,. tami.etchoverrvtdtshl.us <br />dba: Marketplace Solutions <br />dba; Procure America <br />31108 Rancho Viejo Rd. #132102 <br />San Juan Capistrano, CA 92675 <br />... rl�7wfciaF:1 <br />REVISION NUMBER: <br />Z <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 AL. THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />Olt of Santa Ana <br />Y <br />20 Civic Center Plaza <br />TYP&OF INSVRANCE <br />Santa Ana, CA 92701 <br />AUTHORISED REPRESENTTA'TOM <br />L C <br />POIJCY NUMBER <br />oDtti'tiA <br />w. -._—J <br />LIMITS <br />GENERAL. LIABILITY <br />I <br />EACN OCCURRENCE $ 2,096,0 <br />A <br />X ccmmERCIALeewERALUABIuTY <br />CLAIMS -MADE X OCCUR <br />X <br />72SSAAP4101 0110012414 <br />0110612015 <br />p l c � , g 9,690,66 <br />MED EXP jAny one $ m..M••16,66 <br />PERSONAL$ADVINJURY 5 .2,666,000 <br />GENERAL AGGREGATE $4,000,000 <br />w <br />ORNI AGOREG.ATE LIMITAPPLIES PER <br />PRODUCTS-COMPJOPAGG S WW4,00000 <br />PRO- LOC <br />POLICY JFCT <br />5 <br />AUTOMOBILE LIABILITY <br />rSo Mddont INGLE LIMIT 11669,96 <br />'A <br />ANY AUTO <br />728BAAP4101 911661$614 <br />61196/2915 <br />BODILY INJURYlPerpemcn) <br />BODILY INJURY low ocndam) $ <br />$ _.�._,..m......— _ <br />FEED RACCIDENT CE <br />ALL OWNED SCHEDULED <br />ALTOS .AUTOS <br />K HIRED AUTOS )t AIUTTO$ <br />__. <br />S <br />X UMBRELLA UAB J( <br />CCR <br />OCCURRENCE .$. 1,999,90 <br />AEXCBSS <br />LDIa <br />CLA&ASMtA9E <br />72SBAAP4`101 O11OW2914) <br />01t0%l29i5 <br />_EACH <br />AGGREGAEGATE g 1,090,09 <br />DEC K.RETENnCN$. _. 10996 <br />S <br />I WORKMCOMPENSATION <br />I AND EMPLOVER8" LIABILITY <br />�EEMBER£ WJDB�ECUTIVE YY <br />(Mandatoryin NNP <br />NfA <br />-.-----^--^-^�-'^ <br />E.L. DISEASE -EA EMPLOYE S—_..�_ <br />0 adaeafbo under <br />R T N OF OPERATIONaboluw <br />E.L.OISEASE-POLICY LIMIT S <br />DESCRIPTION OF OPERATIONS i LOCATIONS VEHICLES (An oh ACORD 101, Addidoml Romaft Sohaduln, if mom Boom to mqulmd) <br />City of Santa Ana, its officers, adsploaes, agents, volunteers and <br />representatives are named as additional insured where regized by written <br />contract and per the attached policy form SSOCOS(04105) including primary s <br />non -Contributory wording. <br />M1EMTI=f*ATC4 LIM nCO, 4701 Mir 91 I ATN9N <br />SANTAAN <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Olt of Santa Ana <br />Y <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />Santa Ana, CA 92701 <br />AUTHORISED REPRESENTTA'TOM <br />1988-2010 ACORO CORPORATION. All rights reserved. <br />ACORD 25 (2010105) The ACORD name and logo am registered marks of ACORD �"{� 1 I <br />,Cf�I 4P We� �S It <br />i j <br />