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ACC)Rtr CERTIFICATE OF LIABILITY INSURANCE <br />lh_ <br />�...�"� <br />DATE ('YYY) <br />4/6/2016/2016 <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(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 endomement(s). <br />PRODUCER <br />Knight Insurance Services <br />535 North Brand Boulevard <br />CONTACT NySa Gellegoe <br />PHONE (818)662-4200 �F1c,tlal;_(e 14 166x-s1Ls <br />E-MAIL <br />opRESk NysaG@KnightIns.net <br />Suite 1000 <br />Glendale _ CA . 91203. _ <br />INSURER(SIAFFORGING COVERAGE <br />NAICe <br />^__F <br />INSURER A:Liberty Sur4Llus Insurance CoB,na <br />_ <br />10725 <br />INSURED <br />INSURERB De OaitOrB Ine4r8nCi Company <br />- <br />19445 <br />All City Management Services Inc <br />INSURERC:Tha Burlington Insurance DDnny <br />23620 <br />10440 Pioneer Blvd # 5 <br />INSURERD: <br />INSURER E: <br />X <br />Y <br />BERtd Fe Springs CA 90670 <br />INSURER F: <br />I f 4/1/2017 <br />COVERAGES CERTIFICATE NUMBER:16/17 MASTER REVISIONNUMBER: <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 />ILTM <br />TYPE OF INSURANCE <br />N6 <br />IWV <br />l POLICY NUMBER <br />i MOLICV <br />l MM(UOYIYY%W <br />LIMITS T W~ <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />j <br />�' CLAIMS -MADE ExI OCCUR <br />I <br />I <br />EACH OCCURRENCE <br />�S 11000,000 <br />PREM E'YO RENf� � <br />15AMA "I5AarcunBPce1 _ <br />-""' <br />$ 50,000 <br />MEDFXP(Anysnecersen) <br />$ 8%olLLded <br />ITI <br />_ <br />X <br />Y <br />100020084301 <br />4/1/2016 <br />I f 4/1/2017 <br />PERSONAL S AOV INJURY <br />S 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />X I POLICY PRO- <br />_ I JECT I! LOC <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />( <br />{ <br />--__— <br />PRODUCTS-COMPIOP AGO_ <br />$ 2,000,000 <br />_ <br />$ <br />OTHER <br />11 <br />B— <br />AUTOMOBILE LIABILITYi <br />T <br />X ANY AU TO ._^_...-�._»...___ <br />ALL OWNED SCHEDULED <br />_ AUTOS _AUTOS <br />X HIRED AUTO$ R AUTOS NON -OWNED <br />X <br />Y <br />ACP7333954504 <br />f <br />112/21/2015 <br />12/21/201fi� <br />COMBINED SINGLE UMIr <br />(F._ �,( <br />L. -,n nc L1._- <br />$ 11000,000 <br />BODILVINJURYIPerpamon) <br />Y <br />BOOILYINJURY Peracudent <br />I 1 <br />$ <br />AGE- <br />PROPERTY DAMLP4r �eddrtnll <br />�$ <br />UMBRELLA LIAR �� <br />1_J <br />OCCUR <br />EACH OCCURRENCE <br />$ 8, D00, 000 <br />AGGREGATE <br />S <br />$ <br />C <br />EXCESS <br />X EXCESS LIAR <br />(HPPUBB1353 <br />4/1/2016 <br />4/1/2017 <br />DED I X <br />RETENTION$ 0 <br />WORKERS COMPENSATION <br />I <br />I <br />PER OtH <br />AND EMPLOYERS' LIABILITY Yr_N <br />ANY PROPRIETORMARTNERIEXECUTIVE <br />OFFICERIMEM1IOER'rn EXCWOEb4 l! <br />lMes, desryln and <br />If yes, deacdbe under <br />DESCRIPTION OF OPERATIONS helaw <br />I[ <br />NIA <br />INot Applicable <br />EL EACH ACCIDENT <br />ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYE <br />_ <br />$_ <br />G . DISEASE - POLICY LIMIT <br />$ <br />f <br />Not Applicable <br />I <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR0101, Additional Remarks Schedule, may be attached it mora space Is required) <br />Certificate Holder Completed to Read; City of Santa Ana, it's officers, employees, agents, volunteers and <br />respresentatives. <br />As respects General Liability and required by written Contract; Certificate Holder is named as additional <br />insured. Insurance in Primary & Non -Contributory. Waiver of Subrogation applicable. <br />City of Santa Ana <br />20 Civic Center Plaza, M29 <br />Santa Ana, CA 92702 <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 />Kanny Mashhoud/NYSGAL <br />©1988.2014 AC <br />ACORD 25 (2014101) The ACORD name and logo are registered marks or ACORD <br />INS025nmeml <br />All riohts <br />