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CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDONM)
<br />5/2'/2017
<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 p+allcp(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
<br />NTACT
<br />NAME ......, Nysa Gallegos
<br />Knight Insurance Services�%� �
<br />*-+
<br />PHONE (818)662-42 011 � FAI
<br />_ IE11I 662-9312
<br />535 North Brand Boulevard
<br />ADR ss: NysaGB Knightins . net:
<br />suite 1000
<br />INsuRERIs) AFFORDIN13 COVERAr3E NAIL a
<br />Glendale CA 91203
<br />., ,..........., _ _._....__.... __ .... , ......._... . _,_.....,.. m
<br />INSURERAMibart► Surplus Insuranc4 Ca:mpsrn• 70725
<br />....
<br />Ih,.
<br />RED
<br />.. .._.. _. _'..
<br />�� arty' 42587
<br />City Management Services Inc
<br />INSURER!C $ouston. Casual�traCoe ar7,
<br />.. y mp'
<br />10440 Pioneer Blvd # 5
<br />..,, _42374
<br />INSUREROThe Burlington pgj1 ante CWAtpany 2362p ..
<br />INSURER E.,
<br />Santa Fe Springs C74 90670
<br />1NEURERF:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />_ , _.... _.... .........:....
<br />IN5q..... ............. ...,_... ADDL SIJBR ..... ,..._._ ..,.,.,.,.., ,. m .,......_ .... , .... _
<br />LTR TYPE OF INSURANCE POLIoY EF`'`'�'• E+O'LICY EXP' 1 ....... ..... ............. .. ,.. ...........
<br />NUMBER MMtODaYTYY MMaDD1YYYY r LIMITS
<br />X: COMMERCIAL GENERAL LIABILITY
<br />EACH
<br />1,000,000
<br />A
<br />� CI..A.IMS-,MADE � 7C �� OCCUR
<br />i
<br />OCCURRENCE
<br />IStiI�IAGE'1�i RE"NTImD' .
<br />y
<br />x
<br />100020084302
<br />5/1/2017
<br />5/1/2011
<br />MED EIxP Any ang par$o)
<br />Excluded✓
<br />....,..
<br />PERSONAL & AP]w INJURY
<br />$ ,04000
<br />GEN L AGGREGATE LIMIT APPLIES PER:
<br />......
<br />v
<br />GENERAL AGGREGATE _._
<br />$ 2,000,000m.
<br />PRI]
<br />POLICY :LOC
<br />l
<br />...... . ....,
<br />PRODU�IS COMPfOPAGG
<br />..........., .... _.....
<br />....... ..,,_ . ..
<br />S 2,000,000
<br />I�OTER
<br />�
<br />.. .. .....�....,,. .
<br />AUTOMOBILE
<br />LIABILITY
<br />�IIr4ED ,,IN't LW
<br />1, 000, 00a
<br />X
<br />ANY AUTO
<br />�
<br />BcaDrLY INJURY (Par person l
<br />s
<br />ALL OWNED SCHEDULED
<br />AUTOS _. AUTOS
<br />X
<br />ACP7855954504
<br />4/1/2017 4/x/2018
<br />BODILY INJURY (Peracddent)
<br />g
<br />R
<br />HIRED AUTOSAUTOS
<br />'•"f RT 1" 97AImGAG[^ . .
<br />�
<br />......
<br />gP�o-aleer OPcradEPaE)
<br />Ijl
<br />UMBRELLA LUAB OCCUR
<br />tat Layer mrina.rkrl
<br />FACT -7 OCCURRENCE
<br />$ 3�aaa,gawo
<br />Ct
<br />EICCES.SLIAe CU41MS MADEi
<br />_m.....
<br />�'
<br />AGGREGATE
<br />..., ,.,. .. ...
<br />$! QOow,.ola.
<br />...
<br />f
<br />0..1
<br />DED RETENTIONS
<br />a17Xc D744Da
<br />5/x/2017 5/1/2011
<br />WORKERS COMPENSATION'
<br />PERTRH
<br />AND EMPLOYERS' LIABILITY Y I N�
<br />...�.
<br />ANY FFICERO/M SERPEXCLUDED? ECUiIWE
<br />N P A
<br />�
<br />Not App11,r3abxs
<br />E L EAC`h-tl AfikOD>=M1i1
<br />$ _..'
<br />(Mandatory NH)
<br />II as, descrlb+a under
<br />M,
<br />E L DISEASE - EA EMPLOYEEI
<br />.. __._. _.. .... ......._
<br />q
<br />. S
<br />DESCRIPTION OF OPERATIONS below
<br />(
<br />IEL
<br />DISEASE- POLICY LIMIT
<br />D
<br />Rxcess Liability
<br />2nd Layer (Secondary)
<br />5/x/2017
<br />5/1/2018
<br />Each Occurrence in Excessof $5,000,000 coo
<br />$a Retention
<br />l
<br />BFFDO04884
<br />i
<br />G
<br />$3MPrlmaryI_Wt $5,000,000 Agg
<br />DESCRIPTION OF OPSRATIiONS f LOCATIONS I VEHICLES {ACCRO 101, Ad(llaonal Remarks Schad,^ May bs atSaehed It more $puce Is required)
<br />Certificate Holder Completed to Head, City of Santa Ana, it's: officers, employees, agents, volunteers and
<br />respresentati
<br />
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