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CERTIFICATE OF LIABILITYINSURANCE
<br />DATE (MMIDDIYYYY)::
<br />1 3/4i2015
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,. the policy(los) must: be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions ofthe policy; certain policies may require an endorsement, A statement on this certificate does not Confer rights to the
<br />certificate holder in Ileo of such endorsement(s),
<br />PRODUCER
<br />The Empire CompanyPHONERRa,
<br />550 North Park ,Center Drive
<br />Suite 20.5
<br />Santa Ana CA 92705
<br />CNAME:OMIACT SuSen Remeike
<br />FA[ N..
<br />A
<br />-MAIL. .sre'maika@empire-.co.00m,
<br />INSURER$ AFFORDING COVERAGE NAIL
<br />INSURERA Sentinel insurance CoMany, LTD 11000..
<br />INSURED
<br />ARC Mercury
<br />.1942 Blair Ave
<br />Santa Ana CA 92705,
<br />INSURERS:
<br />INSURER C':.
<br />INSURE...O:
<br />:INSURER&6
<br />INSURERP:;
<br />COVERAGES CERTIFICATE NUMBER:15/16 Master REVISION NUMBER::
<br />THIS 1S TO CERTIFY'THATTHE POLICIES OF INSURANCE LISTED BELOA 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S: SUBJECT TO ALL. THE TERMS,;
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. .LIMITS SHOWN. MAY HAVE BEEN REDUCED BY PAID. CLAIMS:
<br />ITR
<br />TYPE OF INSURANCE
<br />ADDLISUBR
<br />POLICY NUMBER
<br />MMIOQIYYYY+
<br />(MM/DD/YY 'I
<br />LIMITS'
<br />AUTHORIZED REPRESENTATIVE
<br />GENERAL LIABILITY
<br />,Santa Ana, CA. 92701
<br />Michael Condy/SUSAN „'"„�1-.<.e.-y+l.
<br />cep-✓-"'"'"
<br />EACH OCCURRENCE $ 1.,000,000
<br />PREMISES EO- nee $ 1,000,000
<br />A.
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE aOCCUR
<br />72SBAAQ6956
<br />[20/2015
<br />/20/2016
<br />MED FOR (Ary one persen-.: $ 10y OQQ
<br />PERSONAL .& ANY INJURY, $ 1,000,00,0
<br />GEN P,$- AOGRCGATE $ 2,000,000
<br />GENL AGGREGATE
<br />LIMIT' APPLIES: PER:
<br />PRADUCTS-COMP/OPAGG. $ 2.,000,000
<br />$
<br />x POLICY
<br />7 PRO. LOG
<br />AUTOMOBILE
<br />LIABILITY
<br />f LIMIT
<br />Ea am ant, 1,000,000
<br />: BODILY INJURY (Per parson) $
<br />A
<br />X
<br />ANY AUTO
<br />ALL OWNED SCHEDULED:.
<br />WIRED AUTOS iC Al0iTOQVNNED
<br />72SBAAQ6956
<br />/20/2015
<br />/20/2016
<br />- BODILY IN;IURY IPs=Ident)
<br />:PR P :Y DAMAGE $
<br />P., d. RRh
<br />X
<br />UMBRELLA LIAB
<br />,(OCCUR
<br />EACH OCCURRENCE $ 1, 000,DQQ'
<br />AGGREGATE $ 1,000,000'.
<br />A
<br />EXCESS LIAR
<br />CLAIMSNADE
<br />DED I $:: RETENTION$. 10,000
<br />$
<br />72SHAAO,6956.
<br />/20/2015
<br />/20/2016
<br />WORKERS COMPENSATION.
<br />AND EMPLOYERS LIABILITY
<br />ANY PROM ETORIPARTNERIEXECUTIVE YIN
<br />OPFICERIMEMBER EXCLUDED?
<br />(Msnd.tory In MR)
<br />N. /A
<br />STAT I 0E H-.
<br />EL EACH ACCIDENT $
<br />E L DISEASE -EA EMPLOYE_ $
<br />EL.DISEASE- POLICY LIMIT $
<br />If yes desorlree Under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 Additional Remarks Schedule, If more space Is required)
<br />Those usual to the Insured's Operations.. City of Sana Ana, Its Officers, Employees„ Agents, and
<br />Representative are an Additional Insured. per the Business: ,Liability Coverge form SS000B attached. Waiver
<br />of Subrogation and Primary Non -Contributing wording per farm S$0008 attached.,np�e
<br />Ilk,�"'U
<br />1
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD25(2010105) 01888-2010ACORD CORPORATION. All rights reserved.
<br />INS025 (201005),01: The ACORD: name andlogo are registered marks of ACORD
<br />Exhibit C
<br />SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL Be'
<br />DELIVERED IN.
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />,Santa Ana, CA. 92701
<br />Michael Condy/SUSAN „'"„�1-.<.e.-y+l.
<br />cep-✓-"'"'"
<br />ACORD25(2010105) 01888-2010ACORD CORPORATION. All rights reserved.
<br />INS025 (201005),01: The ACORD: name andlogo are registered marks of ACORD
<br />Exhibit C
<br />
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