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A� Lig' CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 <br />DATE <br />11/(161/20 6) <br />THIS CERTIFICATE IS ISSUED ASA 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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATIO NIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement <br />on this certificate does not confer rights to the certlficate holder In lieu of such endorsement(s). <br />PRODUCER <br />CONTACT <br />Willis Insurance Services of Georgia, Inc. <br />c/o 26 century Blvd. <br />P.O. Box 305191 <br />PHONE FAX <br />' 877-945-7378 888-467-2378 <br />E-MAIL81 certificates@willis.com <br />Nashville, TN 3723D-5191 <br />INSURER(5)AFFORDING COVERAGE NAIC# <br />INSURERA:Hartford Fire Ina. Co. 19682-001 <br />11/15/2016 <br />INSURED <br />Commonwealth Land Title Company <br />INSURER B; Continental Insurance Company 35269-007 <br />INSURERC:Trumbull insurance Company 27120-001 <br />Attni Riak Mgmt Dept <br />601 Riverside Ave, Bldg 5 <br />Jacksonville, FL 32204 <br />INSURER D: Allianz Insurance Company 35300-001 <br />INSURER E: <br />INSURER F: <br />po99MMaaooN��TT RENT'V <br />PKEMISES aoccurence $ 1,000.,-000 <br />COVERAGES CERTIFICATE NUMBER: 2488.1255 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 />INSR <br />TYPE OF INSURANCE <br />DOL <br />SUB! <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPITR <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />20CSEC90929 <br />11/15/2016 <br />11/15/201 <br />EACHOCCURRENCE $ 11000,000 <br />CLAIMS -MADE OCCUR <br />po99MMaaooN��TT RENT'V <br />PKEMISES aoccurence $ 1,000.,-000 <br />MEDEXP(Anyona arson) $ <br />X Host Liquor Liability <br />_ <br />PERSONAL &ADVINJURY $ 1,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />OENERALAGGREGATE $ 10,000,000 <br />POLICY ❑ JECT F] LOC <br />PRODUCTS-COMP/OPAGG $ 2,000,000 <br />$ <br />OTHER: <br />A <br />AUTOMOBILE LIABILITY <br />20CSEC90930 <br />11/15/201611/15/201 <br />COMBI�EDSINGLELIMIT 1,000,000 <br />(Ea ace dent) $ <br />BOO ILY INJU RY(Per person) $ <br />AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />IxANY <br />BODILY INJURY(Peraccldent) $ <br />HIRED NON0WNED <br />AU7050NLYEAUTOS ONLY <br />Phy Dam 9e <br />if-Insu ed <br />PROPERTY DAMAGE <br />(Peraccldent) $ <br />$ <br />B <br />X <br />UMBRELLALIABX <br />OCCUR <br />6011818715 <br />11/15/201611/15/201 <br />EACH OCCURRENCE S 51000,000 <br />AGGREGATE $ 51000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />DED I RETENTION$ <br />$ <br />C <br />WORKERS COMPENSATION <br />AOS 20WNC90926 <br />11/15/201611/15/201 <br />X <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNER/EXECUTIVEI <br />OFFICER/MEMBER EXCLUDED7 <br />�Mandatory in NH) <br />I yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />E, L. EACH ACCIDENT $ 1,0_00,000 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />E.L. DISEASE -POLICY LIMIT $ 1,000,000 <br />D <br />Bldgs/BPP/B.I. <br />CLP3017110 <br />11 15 2016 <br />11/15/201', <br />Loss Limit: $200 <br />Special W/EQ/FL <br />Valuation Proper <br />Property Quota Share <br />Replacement Cost <br />DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) <br />See attached for additional information: <br />F EViEUV(m[ F3Y': EUNICE HEREDIA (PG I OF &) <br />CERTIFICATE HOLDER CANCELLATION <br />Coll:4991102 Tp1:2101013 Cert:2444-1 '55V4$88-2015ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />000 <br />yD <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 />City of Santa Ana <br />20 Civic Center Drive <br />Santa Ana, CA 92701 <br />Coll:4991102 Tp1:2101013 Cert:2444-1 '55V4$88-2015ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />000 <br />yD <br />