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Client#: 10971
<br />HAPMARK
<br />ACORDT,, CERTIFICATE OF LIABILITY INSURANCE
<br />_DATE
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />/O6I2015
<br />THIS CERTIFICATE IS ISSUED ASA 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
<br />CONTACT Roger W. Smith
<br />Professional Insurance Assoc.
<br />PHDNE 201-559.8155 A
<br />o Ext: AIC, No),201 438-8781
<br />429 Hackensack St.
<br />E-MAIL
<br />ADDRESS: rsmith@pianj.com
<br />P.O. Box 818
<br />EACH OCCURRENCE $2008000
<br />Carlstadt, NJ 07072INSURER(S)
<br />AFFORDING COVERAGE
<br />NAICN
<br />INSURERA: Indiana Insurance Company
<br />INSURED
<br />INSURER B: Excelsior Insurance Company
<br />HAP Marketing Services, Inc.
<br />265 Industrial Way West, Unit 7
<br />INSURER C:
<br />MED EXP (Any one person) $5,000
<br />PERSONAL &ADV INJURY $20001000
<br />Eatontown, NJ 07724
<br />INSURER D:
<br />INSURER E
<br />INSURER F:
<br />GENERAL AGGREGATE $4,000,000
<br />COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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 />/LTR
<br />TYPE OF INSURANCE
<br />NSRLSUBR
<br />MIVD
<br />POLICYNUMBER
<br />MMIDIDmYY
<br />MMIDDIIYYYVV
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />BOP8562339
<br />12/101201412/10/201
<br />EACH OCCURRENCE $2008000
<br />X COMMERCIAL GENERAL LIABILITY
<br />DAMAT RENTED
<br />PREMISES Ea occurrence $5D 000
<br />CLAIMS -MADE � OCCUR
<br />MED EXP (Any one person) $5,000
<br />PERSONAL &ADV INJURY $20001000
<br />GENERAL AGGREGATE $4,000,000
<br />GEML AGGREGATE LIMIT APPLI ES PER:
<br />PRODUCTS-COMP/OPAGG $4,000,000
<br />POLICY PRO X
<br />ECT LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BOP8562339
<br />12110/201412/10/201COMBINED
<br />SINGLE LIMIT $ 1,000,000
<br />Ee eccideni
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accitlent) $
<br />X
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />X
<br />CU8566139
<br />1211012014
<br />12/10/2015
<br />EACH OCCURRENCE
<br />AGGREGATE $5 DDD DDD
<br />EXCESS UAB
<br />CLAIMS -MADE
<br />_I
<br />DED X RETENTION $10000
<br />$
<br />B
<br />WORKERS COMPENSATION YIN
<br />ANDEMPLOYERS'LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />WC8565139 ed
<br />�r,�
<br />�ev)eW
<br />1012014
<br />12/10/201
<br />X WCSTATIb OTH-
<br />LIM E
<br />E.L. EACH ACCIDENT $1,000,000
<br />E. L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />C
<br />`
<br />DESCRIPTION OF OPERATIONS below
<br />E, L. DISEASE -POLICY LIMIT $
<br />Silvia AIA
<br />as
<br />min.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addi Tonal Remarks Schedule, If mare space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents,
<br />volunteers and representatives are additional insureds (additional insureds) with regard to liability and
<br />defense of suits arising from the operations and uses performed by or on behalf of the named insured. This
<br />insurance is primary and
<br />Non -Contributory with any other insurance carrier by or for the benefit of the additional insureds.
<br />(See Attached Descriptions)
<br />City of Santa Ana: Parks,
<br />Recreation & Community Services
<br />Agency
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010105) 1 of 2
<br />#S1379431M137129
<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 />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />RWS
<br />
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