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,ac"RH CERTIFICATE OF LIABILITY INSURANCE <br />111,,.� 6/1/2016 <br />DATEwmloDNYYY) <br />1 6/11/2015 <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. 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(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 Lockton Insurance Brokers, LLC <br />CaN Ac <br />N ME: <br />CA License #01715767 <br />Two Embaroadero Center, Suite 1700 <br />San Francisco CA 94111 <br />PHONE A <br />le Eal. - AIC No: <br />a <br />A13DRRSSI <br />INSURERS AFFORDING COVERAGE <br />HAIG9 <br />(415) 568 -4000 <br />INSURER A: National Fire Insurance Co of Hartford <br />20478 <br />6/1/2015 <br />INSURED ACTIVE, Network, Tile. <br />INSURER B: The Confinontal Insurance Com2any <br />35289 <br />INSURER C <br />$ 1,000.000 <br />1397685 717 Noth Harwood St, Suite 2500 <br />INSURER o <br />CLAIMSMADE X OCCUR <br />Dallas TX 75201 <br />INauRERE: <br />19U ERF; <br />X <br />MED EXP (AnV one persorn <br />COVERAGES 1084882 CERTIFICATE NUMBER: 13529467 REVISION NUMBER: XXXXXXX <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />POLICY NUMBER <br />POLICY EFF <br />MMIDnNYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Y <br />N <br />6016940273 <br />6/1/2015 <br />6/112OL6 <br />EACH OCCURRENCE <br />a 1000,000 <br />PREMSES(Ea00 range <br />$ 1,000.000 <br />CLAIMSMADE X OCCUR <br />X <br />MED EXP (AnV one persorn <br />$ 15,000 <br />Host Liquor Liab. <br />Included <br />PERSONAL A ADV INJURY <br />$ 1,000,000 <br />GENT <br />XI <br />I <br />AGGREGATE UNIT APIPUBS PER: <br />POLICY 'j JECT LOC <br />OTHER <br />GENERAL AGGREGATE <br />L2-000.000 <br />PRODUCTS - COMP /OP AGG <br />s 2 0 <br />$ <br />B <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />6016940239 <br />6/112015 <br />6/1/2016 <br />Ea accident <br />$ 1,000,000 <br />X <br />BODILY INJURY (Per peraw) <br />$ r XXX] X <br />ANY AUTO <br />A O SCHEDULED AUTOS AUTOS <br />H REDAUTOB AUT OVdNED <br />BODILY INJURY Paraccidenl <br />XXXXXXX <br />PROPERTY DAMAGE <br />$XXXXXXX <br />X <br />$ XXXXXXX <br />Comp $500 1 X I Coll $500 <br />UMaRELLALIAB <br />OCCUR <br />NOTAPPLICABLE <br />EACH OCCURRENCE <br />a XX"xXxx <br />EXCESS LIAa <br />CLAIMS -MADE <br />AGGREGATE <br />6 X)( <br />DED <br />I <br />I RETENTION$ <br />$ J(}� <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY OPFICERIMEMER EXCLUDED ?ECUTIVE FN <br />NA <br />N <br />6016940256 <br />6/l/2015 <br />6/1/2016 <br />- <br />X I STATUTE Eft <br />E.L. EACH ACCIDENT <br />$ La.1000 <br />E.L. DISEASE -EA EMPLOYEE <br />$ 1,000,000 <br />(Mandatory In NH) <br />Ifrya describe under <br />DESCRIPTION OF OPERATIONS below <br />E DISEASE - POLICY LIMIT <br />4 1 000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Scheduler may be aaachatl if mom space is required) <br />RE: City of Santa Ana, its officers, agents and employees are Additional Insured tytiI vJdent provided by the policy languago or endorsement issued or approved <br />by the insurance carrier, Insurance provided to Additional Insureds) is primary @nlb�hh�4..00mrlbutory as per the attached endorsements or policy language. <br />a� <br />13529467 <br />City of Santa Ana <br />Attn: PRCSA <br />20 Civic, Center Plaza, M -23 <br />Santa Ana CA 92701 <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 />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />