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QUEEBOR-02 RGCHACANA <br />A4C4C>RL7►" CERTIFICATE OF LIABILITY INSURANCE °A 100/8//8120014TE 214 <br />HIS 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 />Arthur J. Gallagher Risk Management Services, Inc. <br />377 Oak Street <br />Garden City, NY 11530 <br />INSURED <br />Queens Borough Public Library <br />89.11 Merrick Blvd. <br />Jamaica, NY 11432 <br />745.0800_ ___.. n/c Nqp 515 745.0082 <br />INSURERS) AFFORDING COVERAGENA' <br />INSURERA:Citizens Insurance Company of America 31534 <br />INSURER B:Alimerica Financial Benefit Insurance Co 41$40_ <br />INSURER C <br />INSURER D <br />INSURER E: .. .._ _.. _ ............. <br />COVERAGES CERTIFICATE_ NLIMRER- RFVISION NIIMRFR- <br />THIS IS 'r0 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO <br />WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />HEREIN IS SUBJECT TO <br />ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR—__.------_.. ADOLS FB —. -- — -' POLICYE•• POL�XP <br />LTR TYPE OF INSURANCE INBD YdVD POLICY NUMBER 1MMfOD1YYW1 MMI <br />LIMITS <br />A X COMMERCIALGENERALLIABILITY <br />EACH OCCURRENCE <br />y 1,000,00 <br />�y <br />CLAIMS C OCCUR �ZBY9185709 j 0670112014 06101!2015 <br />DAMAGETO REOTE>� <br />R--1'0 <br />-MACE <br />PREMISES {Ea oawrrenge} <br />'00 <br />- _ ! <br />MED EXP {Any ore person) <br />b 10,00 <br />PERSONAL &ADV INJURY <br />b 1,000,00 <br />GEN AGGREGATE AP PLIE.S PER <br />GENERAL AGGREGATEPOLIY <br />S 2,000,000 <br />JLIMIT <br />PRO XJ LOC <br />_ <br />PRODUCTS-COMP/OP AGO <br />$ <br />OTHER', <br />S <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLELIMIT <br />SEa accident) <br />S 1,000,000 <br />B X ANY AUTO AWY9158767 106/01/2014 06101/2015 <br />BODILY INJURY (Per Person) <br />_ <br />E <br />ALLOWNED — SCHEDULED } <br />AUTOS IAUTOS <br />BODILY INJURY(Pera.ident) <br />$ <br />NON -OWNED <br />PROPERTY DAMAGE <br />_ <br />S <br />HIREDAU7G6 AUTOS <br />Peracciden) <br />i <br />S <br />UMBRELLA UAB OCCUR p <br />Revjeweby: <br />EACH OCCURRENCE <br />. <br />EXCESS UAB <br />1C_iAIMS-MADE <br />AGGREGATE <br />3 <br />DED RETENTION$ ( <br />-_ -. <br />$ <br />_ <br />WORKERSCOMPENSATION <br />PER DTH - <br />AND EMPLOYERS' LIABILITY YIN <br />STATUTE_ ER <br />- <br />ANY PROPRIETORlPARTNERIEXECUTIVE c ^ <br />DER EXCLUDED'! NIA Silva CU vas 1( <br />E.L.ELEACH ACCIDENT <br />is <br />(MandaRIMEM <br />(Mandatory In NH) G -I <br />E.L. DISEASE - EA EMPLOYEE 8 <br />DGT^ <br />If yes RIPI I LN under I" <br />ESCRIP rIUN OF OPERATIONS beow l <br />- - - <br />E.L. DISEASE -POLICY LIMIT <br />r <br />r$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe aeached if more space Is required) <br />PER FORM It 4210146 0903 <br />AS RESPECTS TO GENERAL LIABILITY THE FOLLOWING ARE INCLUDED AS ADDITIONAL INSURED <br />The City of Santa Ana, 8s officers, employees, agents, and representative. <br />CFRTIFICATF HOI--OFR CANCFI i ATION <br />V 19UU-2014 AUUKU UORPORATION. All rights reseCVed. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana <br />City <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 />— <br />AUTHORIZED REPRESENTATIVE <br />V 19UU-2014 AUUKU UORPORATION. All rights reseCVed. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />