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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />ll/(2MMIDDIYYYY)
<br />9/2016
<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(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 />CONTACT
<br />NAME: Ha1ze3ee Callejas„
<br />MOC Insurance Services
<br />PHONE (415) 937i-0600 FAX
<br />JAIC, No,.Ext): (415)957-0577
<br />License No. 0589960
<br />_
<br />A nRIESs.hcallejas@mocins.com
<br />44 Montgomery St., 17th Fl.
<br />INS URER(S)AFFORDINGCOVERAGE NAIL#
<br />San Francisco CA 94104
<br />INSURER A:Massachusetts Bay Ins. Ccs. 22306
<br />INSURED
<br />INSURERB:Allmerica Financial Benefit Co. 41840
<br />(Geyser Marston Associates, Inc.
<br />INSURERC:Hanover Insurance _Company_ 31534
<br />,INsURE.RD:Republic. Indemnity .Company of _._..... 43753
<br />1601 Pacific Avenue, Suite 204
<br />INSURER_E:Evanstan Insurance Company 3537$
<br />San Francisco CA 94111
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:2016-2017 REVISION NUMBER:
<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 />(NSR Y BEE
<br />LTR TYPE OF INSURANCE �NINSD[)DI�SU D POLICY NUMBER. MMIDPOLIbdYYYYI (MMMDIYYYY1 (LIMITS
<br />X
<br />COMMERCIAL GENE RAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />,000,000f7AMAGE
<br />A
<br />CLAIMS -MADE Fil OCCUR
<br />DAMAGETO RENTED
<br />PREMISES -(Fa occurrence) I.$ 500,0 00
<br />X
<br />ZDFA49104902 12/1/2016
<br />12/1/2017
<br />MED EXP (Any one person) �$ 10,000
<br />No Deductible Applies
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />POLICY PRO- LOC
<br />PRODUCTS - COfv➢P1OP AGG $ Included
<br />iH OTHER:
<br />...._ 6$ ... ...._. _..
<br />.... ....
<br />AUTOMOBILE LIABILITY
<br />LIMIT $ 1,000,000
<br />aCOMBINED
<br />CcdemtSINGLE
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALLOWVNE.D i SCHEDULED
<br />auTos AUTOS
<br />�
<br />AWFA49004902 12/1/2016
<br />12/1/2017
<br />BODILYINJURY (Peraccident)I $
<br />NON-OWNEDFROPEF2gf
<br />HIRED AUTOS
<br />_
<br />DAMAGE
<br />AUTOS
<br />X Comp $500 f Coll $50D
<br />Per accid_enl)
<br />Uninsured Molorist combined I.. $ 1,000,000
<br />X
<br />UMBRELLA LIAR
<br />X
<br />I OCCUR
<br />FAG"pCGURREN'CE
<br />$ — 4,000,000
<br />C--
<br />EXCESS LEAB
<br />f
<br />CLAIMS MADE
<br />AGGREGATE
<br />= 4,., 000, 000...
<br />DED I X ,RETENTION$ .... 0
<br />X
<br />UHF'A49117102
<br />12/1/2015
<br />12/1/201.7
<br />...........
<br />l$ ,,. --
<br />1WORKERS COMPENSATION
<br />0ER141
<br />yy
<br />AND EMPLOYERS' LIABILffY YIN
<br />STATPER
<br />dJTE .........
<br />-- _
<br />ANY PRGPRIETORP4'ARTNFR/EXECUTIVE
<br />E L. EACH ACCIDENT
<br />$ 1 000 00.0_
<br />OPFICERIMEMDER EXCLUDED?
<br />I (Mandatory in NH)
<br />N t A
<br />3954622
<br />12(1/2016
<br />12/1/2017
<br />- ..
<br />..,.E L DISEASE - EA EMPLOYEE
<br />l .._ r
<br />$ 1,000,000
<br />If yes describe under
<br />.._.... -__
<br />[[ ........—.._.._..__....
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE - POLICY LIMIT
<br />V $ 1 000,000
<br />professional Liability
<br />E08'65356
<br />12/1/201.6
<br />12/1/201.7 Each WttrcngtutllAU $1,000,000
<br />Retention $25,000
<br />Retro Date: 11/11/1976
<br />AGGREGATE LIMIT $2,000,000
<br />DESCRIPTION OF OPERATIONS 7 LOCATIONS I VEHICLES (ACORD 109, Additional Remarks Schedule, may he attached if more space is required)
<br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of
<br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional. Insured: with.
<br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any
<br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of
<br />ypremium.
<br />City of Santa Ana
<br />Executive Director of CDA.
<br />20 Civic Center Plaza M-25
<br />Santa Ana, CA 92701
<br />ACORD 25 (2.014101)
<br />INS025 12DI40fl
<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 />HalKlee C:alle]as/(TCA .s /.r l , .....,r...es. 0
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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