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Client`: 160973 WESTHART DATE (MMIDDIYYYY) ACORDT. CERTIFICATE OF LIABILITY INSURANCE 11/17/2016 1 13YY17 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE, DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME, USI Southwest PHONE (AIC, Na,„NE111): 713 490-4600 713-490-4700 Three Memorial City E-MAIL 840 Lessner, Suite 600 ADDRESS: .... ....... . ..... 07101/2016�07/01/2017 1 NSURER(S) AFFORDING COVERAGE NAIC # Houston, TX 77024, INSURER A: Gemini Insurance Company 10833 INSURED INSURERS Safety National Casualty Corp 15105 Town of West Hartford 50 South Main Street INSURER C! E FRVd,%SIG�.IoccINTurreI nce) West Hartford, CT 061'07 INSURER D: . - - IN SURER E C' IC.;� ,,`'I' INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR LTR . ..... . ......... . . ... . . ..... . ...... A dL_SUBR TYPE OF INSURANCE NSR IWVD POLICY NUMBER OLICY EXP APUIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY PEM000000604 07101/2016�07/01/2017 EACH OCCURRENCE S1'0PQ"PPP Fwi CLAIMS -MADE LA I OCCUR E FRVd,%SIG�.IoccINTurreI nce) .. .... ..... MED EXP (Any one person) X X250,00© . .. . .. . ......... PERSONAL & ADV aNJURY S Retained Limit AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRO- POUCY F7 JECT LOG R .0,GENERAL PRODUCTS-COMP/OP AGG S COMBINED SINGLE LIMIT (Ea accident) $ $ OTHER',: AUTOMOBILE LIABILITY ANY AUTO .. . . . ...... BODILY INJURY (Per person) S BODILY INJURY (Per accident) Per accId nt) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OI HIRED AUTOS AUTOS C. N $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSLIAB CLAIMS -MADE $ DEC RETENTION S B WORKERS COMPENSATION AND EMPLOYERS LIABILITY YINSTATUTE ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIEMMBER EXCLUDED?KNi (Mandatory in NH) NIA SP4054895 $500,000 SIR 07101/2016 0710112017 XEl CTH- FR E.L EACH ACCIDENT $110 00,000 E.L. DISEASE - EA EMPLOYEE $ 'es Ifdescribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Effective Date: March 19, 2015 Description: Consultant Agreement- Institute of Museum and Library Services (IMLS) Leadership Grant City of Santa Ana, its officers, employees, agents and representatives are named as additional insured with respects to the General Liability, when required by written contract. City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 ACORD 25 (2014101) 1:1 of 1 #S19305436IM17946798 (;ANUhLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BZLHA