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u <br />i <br />I <br />J i <br />t I <br />Ii <br />I <br />11. <br />yiF <br />{IS�n <br />i <br />ACC CERTIFICATE OF LIABILITY INSURANCE <br />�1,xn"4y1 <br />THIS CERTIFICATE IB ISSUED AS A MATTER OF TNFORMATION 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 />REPRS$ENTATIVB OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the corORcate ho der s an DI IONAL INSURED, the poncypes) must be endorsed. H SUBROGATION IS WAIVED, subject to <br />the term$ and conditions of the Policy, certain Policies may require an endorsement. A statement On this cortificate does not confer rights to the <br />cerdflo to holder In lieu of such a dorseman s . <br />PRODUCER <br />SILVER CRBBIC INffiURANCB AGENCY <br />ST&VS SCRNRIDER I <br />J d 714 -838 -0693 PA ,714-838 -9430 <br />TSVB ®9ILVSRCRSSICAGSNCX.COM <br />17742 ITtVINS BLVD SUITS 203 <br />^. <br />TUSTIN CA 92780 <br />__ms <br />INS R$RA;HARTyORD CASUALTY INs. CO. <br />INSURSO —� - . <br />INSURER.: HARTFORD II! URANCB COMPANY <br />WRITS NELSON DISHL EVANS LLP <br />2875 MICHELLE, SUITS 300 <br />- <br />IRVINE, CA. 92606 <br />INSURER <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS O TIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT: TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN: THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -_ <br />AO BR —� GY LI 'E UNITS <br />I eR TVPR OP INSURANCE <br />A <br />GENERALUAINUTV <br />CMMERCIALOENER AsuTY <br />CLAIMS-MADE OCCUR <br />$ <br />57SBA <br />1/1/14 <br />6/1/15 <br />EACH <br />OCCURRENCE <br />6 10000 I <br />PREMISES a <br />MEDEMP(Any one peI= <br />— 300000 <br />10 0001 <br />PERSONAL &AOVINJURY <br />6 1D OOOOO'. <br />__ _.. _^ <br />GENERALAOGREGATE <br />6 20000001 <br />'� <br />X <br />570BABP8541 <br />1/1/14 <br />6/1/15 <br />GEN'L AGGREGATE LIMIT APPLIES PER:m� <br />POLICY PR LOC <br />AUTOMOBILE LIABILITY <br />ANY AUTO <br />AUTO ED _ TOD(J RO <br />NON-OWNED <br />HIRED AUi'G9 _AUTOS <br />PRCpUCTS-COMPIOP ADD <br />SW 2000000' <br />y. <br />as IN LIMIT <br />S <br />_.. i0onnnn; <br />BODILY INJURY (Pm Pr l <br />$ <br />BODILY INJURY (PelaaACOM) <br />P PER DAMMA7 — <br />,j!g ec4,tlentl <br />g <br />A <br />UMBRI LIA. <br />EXCESS UAB <br />OCCUR <br />CLNM &MADE <br />X <br />57SBAB378541 <br />1/1/14 <br />6/1/15 <br />EACH OCCURRENCE <br />i 4000000 <br />AGGREGATE_, <br />r <br />6 4000000 <br />WORKER$ COMMNBATION <br />AND EMPLOYERa' LIABILITY pppppp ��/��/ pppppp <br />ANY PROPRUI OP/PARTNENEXECUTIVE <br />pMPW�pbaryylIM%SI�wDED? <br />O a PTID RATI S <br />A H <br />---- <br />B <br />NIA <br />57WECDX4233 <br />6/1/14 <br />6/1/15 <br />EL.EACH ACCIDENT T, <br />E.L.DISEA$E -EA EMPLOYE <br />t__- 1000000 - <br />3 1000400 <br />f..L. DIEEA6E -POLICY LIMIT <br />6 <br />A <br />BuainaaB Interruption <br />5798ABB8541 <br />1/1/14 <br />611115 <br />paSCRIPRON OF OPERATIONSI LOCATION$/ VEHICLE$ (AeaoN ACORD 1p1. AMMWme Wma,Na 6eMedule. Hmon aPw N m9ulndl <br />Those usual to the insured's operational. The City, its officers, employees, agents, <br />volunteers and representatives are additional insured per the business liability form <br />SSOOGS attached to this policy. Coverage is primary and non- contributory per the business <br />liability coverage form SS0008. Wavier of subrogation applies per from WC990006. 30 day <br />advanced notice of cancellation, SO day notice for non - payment Cancellation. <br />William Holt I SK <br />Interim Treasury & Customer service ManagerO <br />City, of Santa Ana M -15 <br />P.O. Box 1964 AOTHO <br />Santa Ana CA 92702 -1964 <br />D POLICIES BE CANCELLED BEFORE <br />NOTICE WILL BE OELIVERED IN <br />ACORD 26 (2010105) The ACORD name and Togo are reoiater6d marks of ACORD „ ,D <br />fflDOI�(I�h <br />�a v <br />