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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYYYY)
<br />5/29/2015
<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(ies) 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 Ileu of such endorsements .
<br />PROPUgER
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<br />SelectSoluUons Insurance Services, LLC
<br />PHONE Eea) 866-600-6359 � juc Nat;,S855) 804.8449
<br />� hL
<br />1350 Carlback Avenue
<br />Walnut Creek, CA 94596
<br />a
<br />APPRUCEd-"
<br />.. G. Ud. LQMp' k3JR. R :.............__...._.._.,.._.------ _, ..... ,.... .__....,,- __,_,._.._.__ _.,,....,...._.,_.___
<br />,,,,,,, -
<br />, ,, INSURER(d� AFFORDING COVERAGE NAIC #
<br />wsuaeD
<br />NsuREna Newyork Marine &General Insurance 16608
<br />Wlseplace, a Ca Corp Dina Wise Silver Center
<br />INSURERS Philadelphia Indemnity Insurance Company._ 18058
<br />---
<br />1411 N. Broadway
<br />Santa Ana, CA 92706
<br />INSURERC
<br />- -- -- - - - -_. , __,.___... ._.... -____
<br />___,._.ER D:
<br />ERE:
<br />NSURERF:
<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
<br />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 />iq'S.ii _...._._._ .._.._...... ""—" " " "00 STAR .... ..._—_._.___...,_ . —.._ .PpOLICY EFN' .POCIEY'EXP_ ..._.._.._.,,_ �_......_.._, .___,..._............_
<br />TYPE INSURANCE
<br />LTR OF POLICY NUMBER umc01'W MM /DDIYYV LIMITS
<br />GENERAL LIABILITY
<br />✓ I COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,0001000
<br />JCLAIMS-MADE I A
<br />Pj2F„MIQEyS„(F;g ggaurrence7 „_,
<br />$ '1,00 000
<br />OCCUR
<br />MED EXp fAny onep¢raonL
<br />A 5--M
<br />B
<br />Yes
<br />PHPK1278336
<br />1/112015
<br />1/112016
<br />PERSONAL BADV INJURY
<br />_
<br />$ 1000000
<br />....... _.._.
<br />GENERAL AG
<br />$ 2000000
<br />OEMLAGOREGATE WMITAPPLIES PER
<br />PRODUCTS- 00 MP /OPAGG
<br />$2,000,000
<br />✓ POLICY PRO" LOL
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMrr
<br />✓,I
<br />II
<br />ANY AUTO
<br />Ea ecCldm!)
<br />S 1,000000
<br />✓
<br />iii ALL OWNED AUTOS
<br />BODILY INJURY (Far person)
<br />$
<br />BODILY INJURY Tsramloonl)
<br />$
<br />a
<br />SCHEDULED AUTO$
<br />Yes
<br />PHPKI278335
<br />111/2016
<br />1/1/2016
<br />PROPERTY DAMAGE
<br />$
<br />_
<br />✓
<br />AIRED AUTOS
<br />(per accident)
<br />✓
<br />NON-OWNED AUTOS
<br />$
<br />$
<br />11
<br />UMBRELLA LIAS ✓ OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000000
<br />B
<br />EXCESS LIAS (,LAIMS MAD[
<br />_.._.__._. . —._
<br />yes
<br />PHUS486326
<br />1/12015
<br />11112013
<br />._ .__.�
<br />AGGRLOATE
<br />__._ „,, ..,_..
<br />_._.. _
<br />$ 1000000 ._.__,___..,...
<br />_....._
<br />DEDUCTIBLE
<br />._._..... _..._,__
<br />�._._........_._-----------
<br />✓
<br />RETENTION $ 10,000
<br />„____.- ........__,.,_..
<br />$
<br />WORKERS COMPENSATION
<br />P/C STATU• OTH-
<br />ANDEMPLOYEftS'LIABILITY YIN
<br />A
<br />AFFIGERMEME R/ PARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? �
<br />NIA
<br />W0201400008039
<br />811612014
<br />011612016
<br />E.L.. EACH ACCIDENT
<br />$ 7,000,000
<br />(Mandatary in NI U
<br />Ifyss doscribeurder
<br />DESCRIPTION OF OPERATIONS
<br />EE,I... DISEASE - EA EMPLOYEE
<br />,._ .................._._._...._... .....
<br />$ 1,000,000
<br />._._-._ ..__..._....,._........._..__..
<br />boloty
<br />I
<br />E.LDISIEASE:i- POI..ICYI..IMIT
<br />$ 1,000,000
<br />B
<br />Professional Liabltry(Errors and Omissions)
<br />PHPK1278335
<br />1/12015
<br />111!2016
<br />$1,000,0001$2,000,000
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ASlach ACORD 101, Atlgillonnl RSmarke SChodula, It more apeca la requlrod)
<br />The City of Santa Ana, Its officers, employees, agents, volunteers and representatives are named as Additional Insured with respect to General LIablllty, policy par
<br />attached endorsement,This insurance Is primary and non - contributory to any other Insurance provided as respects General LIablllty policy per attached
<br />endorsement. The Professional Liabllity Limits shown represent the Per Claim /Aggregate Limits of Liability.
<br />n
<br />U
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />The City Of Santa Ana
<br />20 ClviC Center Plaza
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BB CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE -, -
<br />©1988.2000 ACORD CORPORATION. All rights reserved.
<br />
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