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QUEEBOR-02 RGCHACANA <br />A te' CERTIFICATE OF LIABILITY INSURANCE DATE <br />(MMI DNYYY) <br />111 1 014 <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(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 />PRODUCER <br />INSURED <br />ler Risk Management Services, Inc, <br />11630 <br />Queens Borough Public Library <br />89.11 Merrick Blvd. <br />Jamaica, NY 11432 <br />Allmerica Financial Benefit Insurance Co 141840 <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 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 />LTR TYPE OF INSURANCE INS SU POLICY NUMBER <br />POLICY EFF <br />POLICY <br />LIMITS <br />A X I COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,005,55 <br />CLAMS -MADE OCCUR BY9185709 <br />0610112014 <br />RENTED <br />06101/2016 PREMISES Eaaec,arenee $ 1,000,00C <br />PREMI <br />MED EXP {Any one person! $ 15,555 <br />PERSONAL & ADV INJURY $ 1,000,05 <br />_ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ -2,000,000 <br />PRC- � <br />POLICY ECT LOC <br />PRODUCTS - COMPIOP AGO $ <br />OTHER'. <br />$u <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,655 <br />Es accident) <br />B X ANY AUTO AWY9158767 <br />06/0112014 <br />06/01/2015 BODILY INJURY (Per person) $ <br />ALL. OWNED SCHEDULED <br />BODILY INJURY (Per accident) $ <br />AUTOS AUTOS <br />NON -OWNED <br />PROPERTY DAMAGE $ <br />HIRED AUTOS AUTOS <br />Pare dea _ <br />UMBRELLA UAB OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE $ ...................... <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />IPER OTH- <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE ER. <br />ANY PROPRIETORIPARTNEIVEXECUTIVE <br />E.L. EACH ACCIDENT $ <br />OFFICER/MEMBER EXCLUDED? NIA <br />(Mandatory in NH) <br />E.L. DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />EL.DISEASE - POLICY LIMIT I $ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) <br />PER FORM # 4210146 0903 <br />AS RESPECTS TO GENERAL LIABILITY THE FOLLOWING ARE INCLUDED AS ADDITIONAL INSURED TO <br />,r <br />The City of Santa Ana, its officers, employees, agents, and representative. pyto's� d T <br />Y� <br />5iORC <br />EISA E• <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2014/01) <br />O 1988.2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />M <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />20 Civic Center Plaza -Ross Annex <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2014/01) <br />O 1988.2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />M <br />