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BACKTON -02 VPXKERURKAR
<br />11 CERTIFICATE OF LIABILITY INSURANCE DA101271 014
<br />�--" 1012772D14
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 License #'P 0726293 NAMEACT
<br />Arthur J. Gallagher & Co. insurance Brokers of CA., Inc. PHONE EAX 818_539.2301
<br />--
<br />505 NBrand Blvd, Suite 600
<br />INSURESts) AFFORDING COVERAGE _
<br />INSURERA,Nonprofits' Insurance Alliance of CA
<br />INSURED INSURERS :State Compensation Insurance Fund of CA
<br />Back to Natives Restoration INSURERC:Old Republic Surety Company
<br />PO Box 6539 INSURER 0:
<br />Irvine, CA 92612.6539 .--- -__.....-
<br />INSURER E
<br />rnvFReY;FC CERTIFICATF NI- IMRFR- 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
<br />TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />1NSR TYPE OF INSURANCE ADD - POLICY EFF I POL Y EXP LIMITS
<br />LT D POLICY NUMBER MMiDD/YYYY MMODtWYY
<br />A X; COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 8
<br />1,000,00
<br />D MA ET RE TED
<br />Cl AiMS -MADE ❑X occuR X 201421765NP0 1010172014 14!0112015 PREM73E5 Ee occurrencaj, _ ..& _.,.,.,,_
<br />500,00
<br />_MED EXP (-Any one puson) $
<br />20,00
<br />PERSONAL$ ADV INJURY $
<br />1,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $
<br />2,000,000
<br />POLICY L. jFOT E] LOC PRODUCTS - COMP /OP AGO $
<br />_2,000,000
<br />OTHFR: $
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT '..'$
<br />Ea accident) -
<br />1,000,000
<br />A A NY AUTO 201421765NPO 10/01/2014 10/01/2015 BODILY INJURY(Per person)
<br />ALLOWNED SCHEDULED BODILY INJURY(Peraccidsnt)$
<br />AUTOS AUTOS
<br />JX
<br />NON -OWNED p,.t l.� PROPERTY DAMAGE $
<br />Per accident ___
<br />HIREDAUCS AUTOS Reviewed
<br />_
<br />(✓y.
<br />UMBRELLALIAB �OCOUR t EACH OCCURRENCE $
<br />EXCESS LIAR H c)LAIMSMAUE } AGGREGATE 4
<br />_
<br />DED RETENTION$ w
<br />WORKERSCOMPENSATION y`,tj i. '.,,ry -,. ! PER OTN
<br />STATUTE_ ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />B ANY PROPRIETORIPARTNERIEXECUTIVE 90761FARPOS � %�(31rH9, 10/2612014 10126%2015 E.L. EACH ACCIDENT $
<br />OFFICER /MEMBER EXCLUDED? � NIA
<br />1,000,00
<br />(mandatory in NH) EL .DISEASE - EAEMPLOYEE $
<br />1,000,000
<br />byes, describe ender
<br />DESCRIPTION O ORERATIONS below E. L. DISEASE- POLICV LIMIT $
<br />110001000
<br />A Abuse 201421765NPO 10/01/2014 10/01/2015 OCC /Agg
<br />1,000,000
<br />C Bond W160092079 04113/2014 04/13120151,
<br />12,500
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additional Remarks Schedule, may be attached it more space, is required)
<br />Re: Use of City Premise at 600 E. Memory Lane, Santa Ana, CA 92705. The City of Santa Ana, its officers, employees, agents and volunteers are named
<br />additional insured with respect to the operations of the named insured per the attached CG 2026 endorsement. Such insurance is primary and
<br />non - contributory per the attached endorsement Workers Compensation coverage excluded, evidence only.
<br />/ COT1OIrATc i nee, rAlkli I ATIi
<br />t0 1966 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City f Santa Ana
<br />Y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />—
<br />AUTHORIZED REPRESENTATIVE
<br />t0 1966 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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