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INSUR-1 C IP ID: CT
<br />A► Ria DATE (MMIDDNYYY)
<br />CERTIFICATE OF LIABILITY" INSURANCE 09125/2015
<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 CONTRACTBETWEEN' THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT:, If the certificate holder is an ADDITIONAL INSURED, the policy(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 lieu of such endorsement(s).
<br />PRODUCER
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />NUM IA:S.: m Central Insurance Agency
<br />NAME
<br />Central Insurance Agency, Inc.
<br />93 East Main Street
<br />BY PAID CLAIMS.
<br />(AlfNNo, ExtI: 877-242-9600 FAX
<br />No); 877-243-8995
<br />Smithtown, NY 11787
<br />George GavariS
<br />- --
<br />POLICY EFF POL.IGY Exp
<br />MM/DDlYYYY MMIDDNYYY LIMITS
<br />E-MAIL
<br />ADDRESS: certificates@ciainsures.com
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE... .,.' $
<br />IN'SU`RIER(S) AFFORDING COVERAGE NAIC #
<br />......INSURED
<br />DAMAGE TO TENTED
<br />0912212015 09122!2016(Ea $
<br />INSURER A . Houston Specialty Insurance Co 12936
<br />Insure Protective Security Inc
<br />_..
<br />INSURER B: Infinity C:omercial Auto .......
<br />6200 Stoneridge Mall #300
<br />PERSONAL BADV INJURY LL $
<br />1,000,00,0
<br />Pleasanton, CA 945,88
<br />GENERAL AGGREGATE $
<br />...INSURER C: Endurance Risk Solutions .... ..._.. _...
<br />X POLICY PRO-
<br />JECT LOC '..
<br />PRODUCTS - COMPIOP AGG $
<br />...... . _.
<br />INSURERD:State Insurance Fund
<br />....
<br />...INSURER
<br />OTHER.
<br />$
<br />E ; ..
<br />AUTOMOBILE LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />(Ea accident) $
<br />INSURER F
<br />COVERAGES 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
<br />BY PAID CLAIMS.
<br />INSR TYPE OF INSURANCE ADDL SUER'
<br />RANCE
<br />'....LTR INSR WVD POLICY NUMBER
<br />- --
<br />POLICY EFF POL.IGY Exp
<br />MM/DDlYYYY MMIDDNYYY LIMITS
<br />.....
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE... .,.' $
<br />1,000',.000
<br />CLAIMS -MADE OCCUR X ALS660236-00
<br />DAMAGE TO TENTED
<br />0912212015 09122!2016(Ea $
<br />100,000'
<br />X Assault 8r Battery
<br />MEDD EXP(Any one peoccurrrson)
<br />5,000
<br />X Errors 8r Omission
<br />PERSONAL BADV INJURY LL $
<br />1,000,00,0
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $
<br />2,000,000
<br />X POLICY PRO-
<br />JECT LOC '..
<br />PRODUCTS - COMPIOP AGG $
<br />...... . _.
<br />1,000,000
<br />OTHER.
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINEDSINGLE LIMIT
<br />(Ea accident) $
<br />1,000,000
<br />B ANY AUTO 504-58321-8423-001'
<br />07/1012015 0711012016 BODILY INJURY (Per person) $
<br />ALL OWNED X SCHEDULED
<br />.. AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( ) $
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />(Per accude„nl)
<br />UMBRELLA LIAB X OCCUR
<br />EACH OCCURRENCE $
<br />2,000,000
<br />B X EXCESS LIAR CLAVMS-MADE EXCIO006712301
<br />09/2312015 09122/2016 AGGREGATE $
<br />2,000,000
<br />DED X', RETENTION$ 10,000
<br />$ _..
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS" LIABILITY Y i N
<br />STATUTE, ER.
<br />D 91.00826-15
<br />0512812015 05126/2016 El EACH ACCIDENT $
<br />1,000,000
<br />DNI=ICERIMEET R EACLUDEDXECUTIVE ❑I',.N d A
<br />(Mandatory In NH)
<br />E.L. DISEASE - EA EMPLOYEE: $
<br />1,000,000
<br />IS yes, describe Wunder-
<br />DESCRIPTION OF OPERATIONS below
<br />-- ---- ---
<br />E.L. DISEASE - POLICY LIMIT $
<br />..... .......
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be
<br />if more space is u�����
<br />vearttaclhed
<br />areelCity ofd anta A bolt'! insured on thle gres, aT Lial , andlity eppolicy
<br />M
<br />Winta#
<br />respects to the operation of the named Insured only.
<br />"f�„
<br />.
<br />Una! i.■IulLRW■.a
<br />C ITYSA 3
<br />City of Santa Ana Its officers
<br />Employees, Agents, Volunteers
<br />and Representatives
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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