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OCCUM-1 OP ID: JY
<br />CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOO)YYYY)
<br />06/09/2015
<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 pollcy(les) 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 />INSURED
<br />Fresno, CA 93711
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<br />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 />C EPR POLICTCR{i'.. ....... .....__.__.__ ..�..... ___
<br />LTR TYPEOFINSURANCH IeED WVp POLICY NUMBER MMIpMYYYY MhllDD/YYYY LIMITS _
<br />A
<br />SANTA ANA, CA 92701
<br />COMMERCIAL GENERAL LIABILITY
<br />Anthony Stornetta in•
<br />EACFI OCCURRENCE
<br />$ 2,000,000
<br />_
<br />CLAIMS -MADE OCCUR
<br />X
<br />OHF926284702
<br />08/19/2014
<br />08113/2076
<br />_
<br />IFUME O TEranwL
<br />$ _ 300,000
<br />MED ESP (Any eneperTr
<br />$ 5,000
<br />PERSONAL B ADV WJURY
<br />$ 2,000,000
<br />GENLAGGREGATELINNT APPLIESPER:
<br />GENERAL AGGREGATE
<br />It 4,000,00
<br />POLICY �� 7 LOG
<br />❑
<br />OP AUG
<br />PRODUCT3-COMP/A,_._.._.._
<br />$ .._. _ 4,000,000
<br />_ __—
<br />.._.
<br />OTHER:
<br />$
<br />AUTOMOBILE
<br />"�""-OMBINED
<br />LIAEILITY
<br />SINGLE LIMIT
<br />$ 2,000,000
<br />A
<br />ANYAUTO
<br />OHF926284702
<br />08/73/2014
<br />08113/2016
<br />8001LY INJURY (Per po,son)
<br />$
<br />''--
<br />ALL OWNED -�� SCHEDULED
<br />.___Id.___._.
<br />BODILY INJURY (Per eceldent)
<br />_._........_._._.__._.__...,
<br />$
<br />_
<br />X
<br />AUTOS AUTOS
<br />NON OWNED
<br />TYGt '
<br />PROPERDAMA
<br />$
<br />HIREOAUTOS AUTOS
<br />(Peraunfrot}
<br />—_.,_.._....____..._..
<br />�(
<br />UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE
<br />a 4,000,000
<br />A
<br />EXCESS LAS CLAIMS --MADE
<br />T^
<br />OHF926284702
<br />00/1312014
<br />00/13/2016
<br />AGGREGATE
<br />.. _......_
<br />$ 4,000,000
<br />OED RETENI ION $
<br />$
<br />WORKERS COMPENSATION
<br />X 6TATUTE ERS
<br />AND EMPLOYERS LIABILITY YiN
<br />--",
<br />ANY PROPRIETOR7PARTNEWCXECUTNE
<br />WC430786701
<br />001(}612016
<br />0610612016
<br />C,L EACH ACCIDENT
<br />----
<br />$ 1,000000
<br />—`— ---
<br />OFFICFWMEMSER EXCLUDED? ❑
<br />{Myandatory3nNR}
<br />NtA
<br />F.0 DISEASE -EA EMPLOYEE
<br />$ 1,000000
<br />D6GCRiPTION OF OPERAI'I(7N8 heiow
<br />R.L.DISEASE-POLICY LIMIT
<br />$ 1,000000
<br />C
<br />Professioani Liab
<br />426437068
<br />08122l201A
<br />08/22/2016
<br />LimlVAgg 6,000,000
<br />Claims Made
<br />Retention 26,000
<br />DESCRIPTION OP OPERATIONS I LOCATIONS I VERICLBS (ACORD 101, AddMonat RoMaLke Sehr,dute, ntay he aaachod Honore SP=a Is ItVI ID
<br />THE CITY OF SANTA ANA,ITS OFFICERS, AGENTS, VOLUNEERS, AND EMPLOYEES ARE
<br />ADDED AS ADDITIONAL INSURED AS RESPECTS TO OPERATIONS AND ACTIVITIES OF, OR
<br />ON BEHALF OF THE NAMED INSURED PERFORMED UNDER CONTRACT WITH THE CITY OF
<br />SANTA ANA PER COMPANY FORM BP0448 0106. PRIMARY WORDING PER COMPANY FORM
<br />391.1331.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014101)
<br />Ud 1988,2014 ACORD CORPORATION. All Sigh S reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />�Lo __1
<br />CITY OF SANTA ANA
<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 />20 CIVIC CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />Anthony Stornetta in•
<br />ACORD 25 (2014101)
<br />Ud 1988,2014 ACORD CORPORATION. All Sigh S reserved,
<br />The ACORD name and logo are registered marks of ACORD
<br />�Lo __1
<br />
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