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CERTIFICATE OF LIABILITY INSURANCE DATE (MPAI ®r5/YYYY) <br />5x22/2015 <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 Ga.. rrett/Mosier /Griffit'h;Sistrunk CONTACT <br />Risk Management & insurance Services PHONE" FAX _m.._._. <br />12 Truman <br />E-MAIL <br />No Ext): (949)559 °6700 AIC No): (949)559-6703 <br />Irvine, CA 92620 ADDRESS_ <br />AFFORDING COVERAGE I NAIL # <br />WWW,gmgs.com OB84519 INSURER A: Great Divide <br />_... . ...._. ........ _ . _... ..... ._ <br />INSURED INSURER B: Peerless Ins <br />EEC Environmental <br />One City Boulevard West, Suite 1800 IusuREo-�c:. <br />Orange CA 92868 INsuRERD: NautiluslnsL <br />INSURER E <br />C:0VFRACF9 C IFRTIFICATF NI]MRFR ?A71711711? RFVIRIC] N NtfMRFR: <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 PE OF INSURANCE ADDL SUart POLICY NUMBER. MMLIC YE MGLIC Y XP LIMITS <br />LTR <br />A <br />COMMERCIAL GENERAL LIABILITY <br />GLP2006942 -12 <br />10/31 %2014 <br />10!31 /2015 <br />EACH OCCURRENCE <br />$ 5,000,000 <br />CLAIMS -MADE F/1 OCCUR <br />PREMISES <br />SES Ea oecurrence) <br />.............0 <br />$. 1 D0,000 <br />MEO EX'P (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY —..5 <br />$ 5,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />5,000,000 <br />POLICY I " 1 JECT F � LOC <br />PRODUCTS - COMP /OP AGG <br />$ 5 „000 „000 <br />..... <br />$ <br />OTHER: <br />B <br />.. AUTOMOBILE LIABILITY <br />CBP8977390 <br />10/3112014 <br />10/31/2015 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$..... <br />1,000,000 <br />ANY AUTO <br />BODILY INJURY (Per person) <br />S <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />S �^ <br />..- <br />PROPERTY DAMAGE <br />- ,t„Per accidenl <br />_ <br />NON -OWNED <br />HIREOAUTOS AUT'OS' <br />5 <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE <br />$ <br />DEO RETENTION s <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANYPROPRIETORPARTNERIEXECUTIVE Y� <br />WCA200 8815-12 <br />5124/2015 <br />5124/2016 <br />/ sraruTE OERH- <br />_-..----......—..--- <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory in NH) <br />N I A <br />E.L. DISEASE- EA EMPLOYEE <br />S 1,000,000: <br />II yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />_....-__ <br />E.L. DISEASE -POLICY LIMIT <br />- _........_... ....�. <br />S 1,000,000 <br />D <br />Pollution Liability <br />GCP2006941 -12 <br />10/31/2014 <br />10/31/2015 <br />Each Poll Occurrence $5,000,000 <br />Professional Liability <br />Each Prof Liab Claim $5,000,000 <br />General Aggregate: $5,000,000 <br />DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />All operations of the named insured subject to the terms and conditions of the policies. <br />As respects General Liability coverage, City of Santa Ana, its officers„ agents & employees are added as Additional Insureds <br />and this insurance is primary per ENV2154AO906 attached.. <br />As respects General Liability coverage, a Waiver of Subrogation is hereby included per CG24040509 attached. <br />M <br />j <br />CERTIFICATE HOLDER <br />All operations <br />City of Santa Ana <br />20 Civic Center Plaza <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 />Griff Griffith <br />@ 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />24791.7S2 1 1,f. -15 G /A /LTTA3IP0L,L /E&0; 15-16 WC I Marissa Roma I 5/22./2015 '5:28:211 FPM IPDT'I I Page 1 of 3 <br />