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QUEEBOR-02 IMMVALLANCE <br />CERTIFICATE OF LIABILITY INSURANCE DATEMMIDDffYYY) <br />11;2112016 <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 INSUREII 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 CONTACT <br />NAME., <br />Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX <br />One Jericho Plaza Suite 200 A ) IC, No, E111): (516 745-0800 (A/C , No): (516) 745-0082 <br />Jericho, INY 11753 E-MAIL <br />ADDRESS: <br />INSURED <br />Queensi Borough Public Library <br />89-11 Merrick Blvd. <br />Jamaica, NY 111432 <br />. . . ........................._...m._....._...... <br />INSURER(S) AFFORDING COVERAGE <br />INSURER A: Citizens Insurance Company of America <br />INSURER B: Allmerica Financial Benefit Insurance Co <br />INSURER C <br />INSURER D <br />INSURER E: <br />INSURER F <br />MAIC # <br />31534 <br />41840 <br />COVERAGES CERTIFICATE NUMBER: <br />REVISION NUMBER <br />.. ..... ...... .. .. ..... ............ ........ .... <br />. ... .. ....................... .................... <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 <br />HEREIN 15 SUBJECT TO ALL <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE <br />BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF INSURANCE ADDLSUBR <br />INSD WVD POLICY NUMBER <br />POLICY EFF POLICY EXP <br />... (MMIDDNYyY)­JMMIDDfyYYY� . <br />.. ..... ... LIMITS <br />A X COMMERCIAL GENERAL LIABILITYEACH <br />OCCURRENCE <br />1,000,000 <br />CLAIMS -MADE X OCCUR ZBY-9185709-06 <br />0610112016 0610112017 <br />DAMAGE TO RENTED <br />PREMISES (Ea occurrence) $ <br />1,000,000 <br />MrD FXP (Any one person) $ <br />10,000 <br />. ......... <br />PFRSONAL & AUV INJURY S <br />1,000,000 <br />GEN'L AGGREGATE LIMIT APPLdFS PER <br />GENERAL AGGREGATE S <br />2,000,000 <br />POLICY PRO- <br />JECT X LOC <br />PRODUCTS - CO�MPIOP AGG S <br />Included <br />OTHER <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $ <br />(Ea accident) <br />1000'000�� <br />13 X ANY AUTO AWY9158767 <br />0610112016 0610112017 <br />BODILY INJURY (Per person) $ <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />NON -OWNED <br />PROPERTY DAMAGE S <br />HIRED AUTOS ­ AUTOS <br />(Per accident) <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE S <br />EXCESS LIAB CLAIIMS-MADE <br />CJ <br />AGGREGATE..... <br />PEP <br />1011 <br />S <br />_ __RETENTION$ <br />.WORKERS COMPENSATION <br />­. . ..... <br />PER OTH- <br />AND EMPLOYERS' LIABILITY YINSTATUTE <br />ER <br />ANY PROP'RIETOR)PARTNEXCLUDED? :ER/EXECUTIVNIA E <br />E EACH ACCIDENT <br />OFFICE R/MEMBER <br />(Mandatory In NH) <br />E L DISEASE - EA EMPLOYEE $ <br />If yes, describe under <br />OESCRtlPTION OF OPERATIONS below <br />EJ- DISEASE -POLICY LIMIT $ <br />.. .. ........ <br />DESCRIPTION OF: OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, <br />....... . .... . . . ........ <br />may be attached if more space is required) <br />PER FORM # 421 2915 06 15 <br />The City of Santa Ana, its officers, employees, agents, and representative are included <br />as Additional Insureds <br />CERTIFICATE HOLDER <br />CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City oftn: Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />AtPRCSA <br />20 Civic Center Plaza -Ross Annex . ....... <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />_...m.. .......... . . ..... <br />@ 1988-2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />