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AC01I CERTIFICATE OF LIABILITY INSURANCE
<br />�.
<br />DATE(MMIDDNYYY)
<br />11/16/2015
<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(iii 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(sj.
<br />PRODUCER
<br />CNONMTEACT Erica Hornaday
<br />The Empire Company
<br />PHONE.. AI N
<br />DRIE ,ehornaday @empire- co.com
<br />550 North Park. Center Drive
<br />INSURER. S) AFFORDING COVERAGE.
<br />NAIC N
<br />Suite 205
<br />INSURERA:Sentinel Insurance CoLupany, LTD
<br />11000
<br />Santa Ana, CA 92705
<br />INSURED
<br />INSURER B :Hartford Accident and IndemnitV
<br />22357
<br />INSURER C .Underwriters Lloyds of Landon
<br />1 EXP (Any one person)
<br />Rosenow Spevacek Group, Inc.
<br />INSURER D:
<br />309 W. Fourth Street
<br />INSURER E
<br />72SBAAQ7019
<br />LINSURER F:
<br />1/1/2017
<br />Santa Ana CA 92701
<br />COVERAGE'S CERTIFICATE NUMBER:2016 /2017 Master REVISION 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. 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 />LT
<br />TYPE OF INSURANCE
<br />ADDL
<br />UBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />jMMI DD
<br />POLICY EXP
<br />LIMITS
<br />A
<br />X_.
<br />COMMERCIAL GENERAL LIABILITY '
<br />CLAIMS -MADE n OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES flEa occusrr n.
<br />1,000,000
<br />1 EXP (Any one person)
<br />$ 10,000
<br />72SBAAQ7019
<br />1/1/2016
<br />1/1/2017
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ PE 9 IF X-71.' L 0 C
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />....
<br />PRODUCTS - COMPIOP AGG
<br />$ 2,000,000
<br />Employee Benefit Liability,
<br />$ 1,000,000
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$. 1 , 000 , 000
<br />BODILY INJURY (Per person)
<br />$
<br />'
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />72SBAAQ7019
<br />1/1/2016
<br />1/1/281.7
<br />BODILY INJURY (Per accidentl
<br />X
<br />NON -OWNED
<br />HIRED AUTOS Ix AUTOS
<br />LOPERTY DAMAGE
<br />$
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />''...TIED X RETENTION 10 000
<br />$
<br />72SBAAQ7019
<br />1/1/2016
<br />1/1/2017
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y' I N
<br />ANY PROPRIETORPARTNER)'EXECUTIVE
<br />OFFICEWMEMBEREXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />NIA
<br />72WECVK8727
<br />1/1/2016
<br />1/1/2017
<br />X STATUTE ©TRH_.
<br />-
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1.000 000
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 11000,000
<br />C Errors & Omissions M1151153 3/1,/2015 3/1/2016 LIMIT 2,000,000
<br />Claims Mader Retro 3/1%95 RETENTION 10,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES IACORD 161, Additional Remarks Schedule, may he attached If more space is required)
<br />City of Santa. Ana as Successor Agency to the former Community Redevelopment Agency, The City of Santa
<br />Area, the Housing Authority of the City of Santa Ana, and their officers, employees, agents and volunteers
<br />are named as Additional Insured with primary and non - contributory wording with respect to the gene�:al
<br />liability per form SS00080405 attached. �� -,
<br />GtK I EhIGA I It HULUtK GANGELLATION — I
<br />kgerardo @santa- ana.org
<br />City of Santa Ana as
<br />Successor Agency to the former
<br />Community Redevelopment Agency
<br />20 Civic Center Plaza M -25
<br />Santa Ana, CA 92702
<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 />ica t` Iarnrday/'ERICF+. f" c" _ -' ' " r
<br />1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORN name and logo are registered marks of ACORD
<br />INS025rpnunit
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