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CERTIFICATE OF LIABILITY INSURANCEDATEnrn(MvM �nlA/YYYY)
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<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 BELOW.
<br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(s), AUTHORIZED REPRESENTATIVE
<br />IMPORTANT', ]fine cenRlcete holder Is en ADDITIONAL INSURED, the porcy(Ies) must be andmsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, canals pollciae ,nay require an
<br />endorsamenL A ateterne.I on this cedhlaete does not confer rights to the cedldnaW Holder In Ilea of such sakdo,nends).
<br />PRODUCER
<br />CONTACT
<br />NAME: STEPHANIE CHU
<br />AON RISK INSURANCE SERVICES WEST, INC.
<br />707 WILSHIRE BLVD, SUITE 2600
<br />LOS ANGELES, CA 90017
<br />PHONE
<br />(AIC,No,Ext) 213-630-2032 (AIc,Nal 847-953-1823
<br />EMAIL stephanie.chu@aon.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NA IC #
<br />INSURED
<br />INSURER A:ACE American Insurance Company
<br />22667
<br />The Walt Disney Company at al
<br />500 South Buena Vista Street
<br />INSURER B: Indemnity Insurance Company of North America
<br />43575
<br />INSURER C:
<br />Burbank, CA 91521-6709
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER : 12863 REVISION NUMBER
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED
<br />BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION
<br />OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
<br />ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE
<br />POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
<br />SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
<br />PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADPL
<br />Irl
<br />s BR
<br />VNO
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNYYY)
<br />POLICY EXP
<br />(MMIDDIYYYY)
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />✓
<br />HDOG27396926
<br />06130/2015
<br />06/30/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS OCCUR
<br />]COMMERCIAL
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />$ 1,000000
<br />MED EXP (Any one Person)
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />r/ POLICY ❑PROD-[7LOC
<br />ECT
<br />GENERAL AGGREGATE
<br />$1,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$1,000,000
<br />OTHER
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO SCHEDULED
<br />ALL OWNED AUTOS
<br />✓
<br />ISAH08858779
<br />66/30/2015
<br />06/30/2016
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY(Per Person)
<br />AUTOS ,/ NON -OWNED
<br />HIRED AUTOS AUTOS
<br />BODILY INJURY(Per Accident)
<br />✓
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />Self-insured for
<br />t✓
<br />Physical
<br />Damage
<br />UMBRELLA
<br />F—JOCCUR
<br />EACH OCCURRENCE
<br />EXCESS 11-1
<br />CLAIMS
<br />AGGREGATE
<br />DED❑ RETENTION$
<br />B
<br />WORKERS COMPENSATION AND YIN
<br />EMPLOYERS' LIABILITY
<br />SCFC48588803 (W)
<br />06/30/2015
<br />06/30/2016
<br />M✓R OTHER
<br />STATUTE
<br />A
<br />WLRC48588773 (AOS)
<br />06/30/2015
<br />06/30/2016
<br />A
<br />WLRC48688785 (OR)
<br />06/30/2015
<br />06/30/2016
<br />ANY PROPRIETOR( PARTNERSI 0
<br />EXECUTIVE OFFICERIMEMBER
<br />N/A
<br />E.L. EACH —ACCIDENT
<br />$1000,000
<br />E. L. DISEASE - EA
<br />$1,000p00
<br />(Mandatory In NH)
<br />If yes, descdbaunden
<br />E.L. DISEASE -POLICY
<br />$1,000.000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />XS Workers' Comp and Employers
<br />WCU04858875A (CA)
<br />06/30/2015
<br />06/30/2016
<br />EMPLOYERS LIABILITY
<br />$ 1,000,000
<br />A
<br />XS Workers' Comp and Employers
<br />VVCUC48588761 (FL)
<br />07/01/2015
<br />06/30/2016
<br />EMPLOYERS LIABILITY
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES (ACORD 101,
<br />Addhional Remarks Schedule, may be attached if more spaceis re« r@ql)
<br />See additional insured endorsement.
<br />{U `f
<br />�e
<br />Rev, `�
<br />r-
<br />Cue� as
<br />CERTIFICATE HOLDER
<br />CANCELIsWTrN
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE C (BED POLICIES BE CANCELLED BEFORE THE
<br />Attrl PRCSA
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />20 Civic Center Plaza - M-23
<br />POLICY PROVISIONS.
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />AON RISK INSURANCE SERVICES WEST, INC,
<br />01088-2DA ACORN CORPORATION. All rights, meeryed.
<br />ACORD 25 (2814/01) The ACORD name and logo are registered marks of ACORD
<br />
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