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211069 <br />AC"RIX CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDDIYYYY) <br />THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />4/1/2015 <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 <br />CONTACT <br />NAME: Cory <br />Commercial Lines - (8.18) 464-9300 <br />PHONE 818 464-9458 1 L 866-968-5687 <br />(A1C NoExt); AIC, No, <br />Wells Fargo Insurance Services USA, Inc. - CA Lic/P OD08408 <br />_ - <br />E-MAIL calherinD.cor c1)wellstarco.com <br />yG <br />15303 Ventura Boulevard, 7th Floor <br />ADDRESS;._ J <br />- -. <br />Sherman Oaks,91403-3197 <br />INSURERS) AFFORDING COVERAGE NAIC Al <br />INSURERA: Philadelphia Indemnity Insurance Company 18058 <br />INSURED <br />Employers Compensation Iris Co 11512 <br />Discovery Science Confer of Orange County <br />,INSURERS: <br />- - -- — 1 <br />2500 North Main treat <br />INSURER C <br />PREMISES (Ea occurrence}-_ <br />INSURER D <br />Santa Ana, AJ2 05 <br />..-- ..._-. <br />INSURER E: <br />INSURER 1_: <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 <br />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 />AODL'SUBR " -_-. _.-_—._-_._ __ ...- -...-. _ <br />LTR ! TYPE OF INSURANCE INSO I POLICY EFF POIDDIY XP <br />VDI POLICY NUMBER I MMIDDIYYYY I MM/DDIYYYY LIMITS <br />X COMMERCIAL GENERAL LIABILITY <br />A <br />X <br />PHPK1269512 <br />12/15/2014 <br />12(15!2015 <br />EACHOCCURRENCE <br />$ 10oo,00D <br />( <br />CLAIMS MADE I..X OCCUR <br />_ <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence}-_ <br />$ 1,000,000 <br />.. -.... __.. <br />MED EXP (Any one person) <br />$ 2D,000 <br />-- <br />PERSONAL 8 ADV INJURY <br />$ 1,000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER <br />- <br />-.-_ <br />._ ..._.I <br />PRO- <br />GENERAL AGGREGATE <br />$ 2000,000 <br />X POLICY JECT LOC <br />— <br />F <br />(PRODUCTS - COWIPlOP AGG_ <br />- <br />- <br />$ 2 000,000 <br />OTHER: <br />I <br />- <br />Sexual AbuselMoaslauon <br />- <br />$ included <br />,c� <br />AUTOMOBILE <br />ABILITY <br />0 <br />K126J512 <br />1�/15/20141 <br />( <br />COMBINED SINGLE OMIT <br />$ <br />I X <br />I <br />(12/15/2015 <br />{Ea accident) <br />1,000,000 <br />f <br />AUTO <br />I <br />BGDILYINJURY(Perporson) <br />f $ <br />ALL OWNED f SCHEDULED <br />i <br />AUTOS I AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />_ <br />X <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />I <br />PROPERTY DAMAGE <br />(Per accident) <br />-- -"-- <br />$ <br />i <br />i <br />I$ <br />A <br />X <br />UMBRELLA LIAR X <br />I <br />c <br />PHUB483491 <br />12/15/201411 <br />12/15/20151 EACH OCCURRENCE i <br />$ I0'0U0'600 <br />EXCESS LIAR <br />_ <br />COCCUR <br />__. ......_. _ MADE <br />1 I AGGREGATE <br />$ 10,000 OLIO <br />DED RETENTION $ <br />1 <br />- <br />$ <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />EIG1453813-03 <br />� 04/01/15 <br />04101(16 X '�� PER 0TH- <br />STATUTE <br />VIN <br />ANY PROPRIE rORJPAf41NERILXECUTIVE <br />OFFICER/MEMBER EXCLUDED? UI <br />N I A <br />i <br />I <br />._ _ <br />� <br />E,L. EAGH <br />_- ACCIDENT -..... <br />i W,000 <br />$-. - O , <br />( y I <br />E.L. DISEASE , EA EMPLOYEE! <br />_ <br />$ 1,000,ODO <br />describe under <br />D11 ESCRIPTION OF OPERATIONS below 1 <br />I E.L. DISEASE - POLICY LIMIT <br />$ 1,000,000 <br />I <br />i <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) <br />The City of Santa Ana is included as Additional Insured for General Liability as required by written contract. <br />DISCOVERY SCIENCE CENTER A-2013-028-01 REVIEWED BY EUNICE HEREDIA (PG 1 OF 2) <br />uM1V tr1eLLM I IUIV <br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Public Works Agency, M-21 ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />P O Box 1988 AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92702 � <br />iii. r'\�.. vrlV 110111. al1U IUYU dlU IC1JIOLUICU nlarKS eI I-NUUML) v IVOU-Zu14 ACUINU CORPORATION, All rights reserved. <br />ACORD��(�ta14"��' 11111111 Il11111111111111111111111111111111111111111111111111111111111111 II 111� <br />'CYI II i A0 U11111067i 1211` 1,'0'010' <br />