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50A A6-46k�l�&uT
<br />OCCUM-1 OF ID: JY
<br />ATE (MMIDDAMY)
<br />, i%. e ° CERTIFICATE OF LIABILITY INSURANCE 00811212015
<br />�.•/ 08(12/2015
<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 />( -PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />..,PORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 />certificate holder In !leu of such endorsement(s).
<br />PRODUCER
<br />Agri -Center Insurance Agency
<br />2660 W. Shaw Lane, Suite 102
<br />Fresno, CA 93711
<br />Anthony Stornetta
<br />CONTACT Kiln Cameron
<br />NAME:
<br />FAX
<br />Arc o s • 659-233.0123 A10 Net., 559-266-8858
<br />n oARE,a. klm@agricenterinsurance.com
<br />INSURER(Sl AFFORDING COVERAGE NAICN
<br />INSURER A: American Cas Dalt Co Of Reading
<br />INSURED Occu-Med, Ltd.
<br />INSURERS: Citizens Insurance Co of Amor 31534
<br />2121 W. Bullard
<br />Fresno, CA 93711
<br />INSURERC:Contlnental Casualty Co, 20443
<br />EACHOCCURRENCE $ 2,000,000
<br />INSURERD:
<br />INSURER E;
<br />_
<br />INSURERF:
<br />08113/2016
<br />COVERAGES CERTIFICATE NUMBER: 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 />(LTR
<br />TYPE OF INSURANCE
<br />O
<br />AUTHORIZED REPRESENTATME
<br />pOUCY NUfd BER
<br />MM/DD
<br />MwDUfYYYY
<br />LIMITS
<br />B
<br />X COMMERCIALGENERAL LIABILITY
<br />EACHOCCURRENCE $ 2,000,000
<br />CLAIMS -MADE M OCCUR
<br />X
<br />OHF926284704
<br />08113/2016
<br />0811312016
<br />PREMISES UE. occvr.rcol $ 300,000
<br />MED EXP (Any onepoison) $ 5,000
<br />PERSONALS ADV INJURY $ 2,000,00
<br />_
<br />BERL AGGREGATE LIM N APPLI ES PER:
<br />GENERAL AGGREGATE $ 4,000,000
<br />X POLICY L] jECT [- I LOC
<br />PRODUCTS -COMPJOP AGO $ 4,000,00
<br />$
<br />OTHER:
<br />YUTOMOBILELIABILITY
<br />EaacdPeDISINGLE LIMIT 6 2,000,000
<br />LHANYAUTO
<br />OHF926284704
<br />08/13/2016
<br />08/1312016
<br />BODILY INJURY (For person) $
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIREDAUTOSX NON -OWNED
<br />AUTOS
<br />BODILY INJURY(Paremtden0 $
<br />PROPER O E 6
<br />a accldenl
<br />X
<br />UMBRELLA LIAR
<br />XOCCUR
<br />EACH OCCURRENCE $ 4,000,00
<br />AGGREGATE $ 4,000,000
<br />B
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />OHF926284704
<br />08/1312016
<br />08/1312016
<br />DED I I RETENTIONS
<br />$
<br />A
<br />WORKER$ COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY
<br />N YPRONEMBOREXCLUOED�CL" YIN
<br />(Mandatory In NH)
<br />eyea describe under
<br />DESdRIPTION OF OPERATIONS below
<br />N/A
<br />0430786701
<br />06106/2015
<br />0610612016
<br />X PER OTN-
<br />STATUTE Eft
<br />EL EACH ACCIDENT $ 1,000,00
<br />E.L. DISEASE -EA EMPLOYE N $ 1,000,00
<br />E.L. DISEASE - POLICY LIMIT S 1,000,00
<br />C
<br />Llab
<br />425437058
<br />08122/2016
<br />08122/2016
<br />LImiUAgg 6,000,00lalms
<br />[Professional
<br />Made
<br />Retention 26,00
<br />DESCRIPTION OF OPERATIONS r LOCATIONS /VEHICLES (ACORD 187, Additional Remarks Schedule, may be attached ff more space is required)
<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 RP0448 0106. PRIMARY WORDING PER COMPANY FORM
<br />391.1331.
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 26 (2014101)
<br />®1988-2014 ACORD CORPORATION. All rights reserved. (IA
<br />The ACORD name and logo are registered (narks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<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 REPRESENTATME
<br />Anthony Stornetta
<br />ACORD 26 (2014101)
<br />®1988-2014 ACORD CORPORATION. All rights reserved. (IA
<br />The ACORD name and logo are registered (narks of ACORD
<br />
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