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<br />A�CORC? CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
<br />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 CONSS��T�ITUTf A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />- REPRESENTATIVE OR PRODUCER, AND T C¢ ,FIC TE �I'OLINN,/ -
<br />IMPORTANT: If the Certificate holder Is a DITIONAL INSURED, the pollcypas) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terns and conditions of the policy, certain
<br />pollcles ray niquhe an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu r `TT ' ' --
<br />of such endorse A i <_,
<br />PRDDUCER r'." (T°
<br />The Empire company �I. -t -1"
<br />PAOme. Susan Remeika
<br />Ax
<br />AC AX
<br />- AX NO;
<br />550 North Park Center Drive
<br />PREMISES EB OCpAlfenaa $
<br />Ao ,sremeika @empire— CO.com
<br />Suite 205
<br />INSURER(B)gFFORDINO COVERAGE
<br />NAIC#
<br />Santa Ana CA 92705
<br />INSURER A:Peerleas Indemnit Insurance
<br />z18333
<br />INSURED
<br />Cor L. L. C.
<br />INSURER$:Golden -a le Insurance Cam an
<br />z10836
<br />INSURER C' 10 era COm ensation Ins. CO
<br />2,000,000
<br />COrbiz, LLC, $ Delaware Limited Liability Co.
<br />P. 0. Box 10627
<br />INBURERD:
<br />INSURER E:
<br />aawldenl $
<br />N/A N/A N/A BODILY INJURY (Per oerson) $
<br />Ee hyr Cove NV 89448
<br />INSURER F
<br />COVERAGES CaaTMICATC Wu mssmn a /, o m._
<br />__......_. .._.,_... _.... - -, _. -...a --I-- ,,,, KEVI51ON 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. NOTWN'HSTANDING 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS,
<br />TR TYPE OF INSURANCE
<br />Well
<br />POLICY NUMBER MMIODIYY W LIMITS
<br />X COMMERCIAL QENERAL LIABILITY
<br />A CLAIMSMADE OCCUR
<br />EACH OCCURRENCE $
<br />DAMAGERf RENTE1i"'
<br />1,000,000
<br />I
<br />PREMISES EB OCpAlfenaa $
<br />100,000
<br />CEPOI11797 2125/2016 2/25/2017 MED EXP(Any one person) $
<br />10,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />PERSONAL &ADV INJURY $
<br />1,000,000
<br />X POLICY �T �LOC
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />PRODUC7S. 00 MP /OPAGG $
<br />2,000,000
<br />OTHER,
<br />AUTOMOBILE LIABILITY
<br />ANYAUTO
<br />ED
<br />aawldenl $
<br />N/A N/A N/A BODILY INJURY (Per oerson) $
<br />AUTOS AUT09ULED
<br />NON- OV.NED
<br />BODILY INJURY (Par awed enn $
<br />HIRED AUTOS AU70S
<br />DA GE
<br />Par accident $
<br />X UMBRELLA UAR1 ,„ ( X 1 OCCI%R
<br />$
<br />B EXCESS LIAR 1 I`CL,41M6 -MADE
<br />EACH OCCURRENCE $
<br />10 000 000
<br />DED RE TION
<br />AGGREGATE $
<br />CV8112197 2/28/2016 2/26/2017
<br />10 000 000
<br />tU
<br />_ $
<br />ANDEMPS YERTU
<br />ANDEMPLOYER9'UABILITY , '; YIN
<br />PER OTH-
<br />X STATUTE ER
<br />ANY PERIMEMTORIErµ1jLNERIEXEI.�JjIVE
<br />OFFICEtoryin FR EXCI.IYDED2 N /A"
<br />C
<br />EL EACH ACCIDENT $
<br />1 OOtl 000
<br />(MAndatoryln NH) 7 �,
<br />Iryy90s desOnbe under .
<br />DESGIRIPTIONOfO pTION'
<br />E101721220 -02 8/1/2915 0/1/2016 EA EMPLOYE $
<br />EL DISEASE -
<br />1 000 000
<br />d
<br />EL DISEASE - POLICY LIMIT $
<br />1 OOp 000
<br />DESCRIPTION OF OPERATIONS, LOCATIQNSI VEHICLES (ACOR0101, Additional Remarks SOP
<br />ewk VV WnAd P more epaCa I In
<br />�3y: Cal ..
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<br />LD,a, te:
<br />Page L of.
<br />CERTIFICATE HOLDER
<br />_...__.. -_._..
<br />City Of Santa Ana
<br />Its Officers, employees, agents,
<br />volunteers and representatives
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014/01)
<br />INS025 (201401)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED 82PORE
<br />THE EXPIRATION DATE THEREOP, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />AUTHORIZED
<br />Coady /SUSAN
<br />® 1988.2014
<br />The ACORD name and logo are registered marks of ACORD
<br />
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