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ACC?R& CERTIFICATE OF LIABILITY INSURANCE �./ DATE(MMIDDIYYYY) 8/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREFI AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,. certain pollcles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tami Larsen All Mutual Insurance Agency CA License # 0574081 CICO No Ext: (626) 795-9595 FAX No: (626)793-7869 ADDRESS: larsent@mutualinsagcy. com INSURER(S)AFFORCING COVERAGE NAIC# 30 N. Marengo Ave Pasadena CA 91101 INSURERA:American States Ins Cc 19704 INSURED INSURER B: INSURERC: EACH OCCURRENCE $ 1,000,000 _DAYA MDG Associates, Inc. 10722 Arrow Route, ,Suite 822 INSURER O: INSURER E: Rancho Cucamonga CA 91730 1 INSURER F'. ESORENTED 20 0 PREMISES .(Ed ocounsnoe 0 $ , OD COVERAGES CERTIFICATE NUMBER:2015-2016 GL .REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH. POLICIES, LIMITS SHOWN MAY HAVE BEEN. REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL il SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYV LIMITS X COMMERCIAL GENERAL LI ABILITY EACH OCCURRENCE $ 1,000,000 _DAYA A CLAIMS -MADE XI ESORENTED 20 0 PREMISES .(Ed ocounsnoe 0 $ , OD MEN TXP(Any one person) $ 10,000 X OICIOD917010 7/1/2015 7/1/2016 PERSONAL &ADV IN-URY $ 1,000,000 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 GENII X POLICY ❑P10 ElLOC PRODUCTS-COMP/OP AGA $ 2,000,000 Employee Benefits $ 1,000000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLELIMII $ 1,000,000 Ea acoldent BODILY INJURY(Per person) $ A ly ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS'XHIRED OIC270073540 7/1/2015 7/1/2016 BODILY INJURY(Per accident] $ AUTOS X AUTN08�ED PROPERTY OPER ntDAMAGE $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4 000,000 AGGREGATE $ 4,000 000 A X EXCESS UAB CIA I MSMADE DED X RETENTION$ 10-000 X OIXS14991700 7/1/2015 7/1/2016 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERAXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? NIA PER 0TH=. STATUTE I I ER EL EACH ACCIDENT $ - E. L. DISEASE- EAEMPLOYEE $ {MandatorylnNN) If yos, de SCflbB under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES tACORO 101, AddWoral Remarks Schedule,: maybe attached irmore space is redulred) The City of Santa Ana, its officers, employees, agents and volunteers are named Additional Insured, but only as respects the Insureds Operations as it relates to their Signed Contract in regards to the CDBG Administration Consulting Services per Form CG8674 attached. .Primary Insurance and Transfer of Rights of Recovery Against Others is included per Form CG0001 attached.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Terri Eggers, Senior Mgmt. Analyst AUTHORIZED REPRESENTATIVE 20 .Civic Center Plaza Santa Ana, CA 92701 Howard Wooaton/TLL 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD I NS025 (20140 1) F 11