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171003
<br />A< � CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />Iki. ''_ 12/22/2015
<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. THIIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), 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 Ileu of such endorsement(s).
<br />Commercial Lines 818 4C4-930CI NAME;T Catherine Cory
<br />PRODUCER CONTACT
<br />( � PHONE ,�,...
<br />_(AJr N9, Xtt 818_484 04�8 AI4 rJu1- 8C=IC s968-5t187
<br />Wells Fargo Insurance Services USA, Inc.. CA Lictk: OD08408 E-MArL
<br />AbORESS: rratllerine.caryCc�welisfargo com
<br />12303 Ventura Boulevard, ! th Floor INSURERgsg AFFORodNG COVERAGE NAIL tk
<br />Sherman Oaks, CA 91403-3197 .. INSURER A. Philadelphia Indemnity Insurance Company � 18058
<br />INSURED _ _._._
<br />' d,. INSURER B Employers Compensation Ins Co 11512
<br />Discovery Science Center of Orange County = (' � � � � P' ._,,.._ —�...
<br />INSURER c--
<br />-—
<br />dba Discovery Cube Cringe County INSURER 0 ;
<br />---
<br />150() N. Main Street INSURER E .
<br />Santa Ana, CA 92705 INSURER F ;
<br />COV`FRA(4F.R l^PPT1F:lr`AT5Z MI IRAMI=c«. C3011QOQ'2
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED` NAMED OR HE POLICY
<br />NAMED ABOVE FOR TFIF POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND%TION OF
<br />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
<br />REDUCED BY PAID CLAIMS.
<br />AISbL'9URRrPOLICY NUMBER
<br />LTR TYPE OF INSURANCE
<br />INSIT a(M COMMERCIAL GENERAL LIABILITY
<br />mm -
<br />PoUt
<br />yl�INSDWVII--
<br />LIMITS -
<br />A X PHPK14:32448
<br />CLAIMS -MADE % OCCUR
<br />......�.. I
<br />12r151c()15 12/YD5t2�18 EACHOCCURRENCE. I $ 1000000
<br />—
<br />�DAMAO� O RENTeb
<br />Pf2FMISES Ea oecuereece} S 9 (30ia,0047
<br />—_., .......�._.,.. .._ ,_m,m..
<br />MED EXP (Any one person) $ 20 004
<br />FPERSONAL & ADV INJURY $ 1,000,000
<br />GEAGGREGATE N'LAGGREGA1
<br />POLICY PRO
<br />....._ __._ ........... v...
<br />GENERAL AGGREGATE S.... 2,000ODO
<br />JEI.'i LOC
<br />!' ( PRODUCTS - COMP/OP AGG 5 2,000,000
<br />E OTHER:
<br />% Sexa;aIlAYau�elMOlestaiicr� $Inulu€9ed
<br />''.. %!,
<br />AUTOMOBILE LIABILITY'
<br />F—
<br />PHP'K1432448
<br />12r15/2015 12r15/2010 COMBINED SINGLE LIMIT $ g 90f1,()gGJ
<br />ANY AUTO
<br />BODILYINJNJp_
<br />EODILURY qPe¢ parson)�$
<br />ALL OWNED SCHEDULED
<br />_. AUTOS AUTOS
<br />x H&RED AUTO 5 X NON-O'vWNED
<br />AUTOSar
<br />�
<br />y SODID_Y INJURY Per accident
<br />I 1�....,
<br />0IYHRTY DAMAGE
<br />$
<br />rPR
<br />accident)_ -
<br />A
<br />MBRE LLA LIAR x
<br />_
<br />PFI l9H524655
<br />12/15/2015 12r1512L 18 EACH OCCURRENCE
<br />I -
<br />$ 10,000 000
<br />COCCUR LA M5-MADE
<br />EXCESS
<br />S LIAB
<br />_
<br />J
<br />AGGREGATE
<br />-__-_-
<br />$ 16 000,000
<br />�_,..
<br />DED RETENT9ON $
<br />f S
<br />B
<br />iWOR'KERSCOMPENSATION
<br />AND EMPLOYERS' LIABOLITY YIN �
<br />EIG1453$13-t73
<br />04101i15 Q41�91r1s X PER OTH-
<br />___ STATUTE _ER ....._ ..... —
<br />ANYCERIMEMB RIPACLUDEDXECUTIVE �I
<br />i� N IA
<br />OFFiCERIMEM®ER EXCLUDED? LEI!
<br />In NH)
<br />If ns describe
<br />If ya�'s d®scntsa under
<br />E..L EACH ACCIDENT T,0�7{J[117n
<br />-
<br />�
<br />DESCRIPTION OF OPERATION'S below00
<br />E,L DISEASE - POLECYPLIMIT 5 B,Up�,00�
<br />I
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES iACORD 101, Additional Remarks Schedule,
<br />may be attached If more space is required) 1
<br />The City of Santa Ana, Parks, Recreation and Community Services Agency is included as Additional Insured for Q 6fablity as required written
<br />contract.
<br />�
<br />A " C'
<br />10 V
<br />XA ry�
<br />City of Santa. Ana, its officers, agents, and employees
<br />Parks, Recreation and Community Services Agency
<br />20 C:Ivic Center Plaza
<br />Santa Ana CA 92701
<br />vnew�u ce a.�n i
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE �]
<br />ACORD 26 (2014/01)
<br />I ne ma.,vreu name ana logo are lregisterea rnarKS of ACCORDU 1988-2014 ACORD CORPORATION. AIl �ri,ghts reserved,
<br />I11111111IIIlIllllllIll)lullIlllll IN 1111111111 lull11111111111111111111 1111l 1111 it llll) L 1A21tuU6Jf ,},a;,;r;f„
<br />
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