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AcOR ®® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD Y")
<br />4/1/2015
<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 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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />NAME: Jonathan Thomas
<br />IPHICONE, Exit 415-946-7500 AIC No: -7
<br />Frank Crystal & Co., Inc.
<br />dba Crystal & Company
<br />32 Old Slip
<br />E -MAIL
<br />ADDREss:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC q
<br />New York NY 10005
<br />INSURER A : m
<br />/1/2015
<br />EACH OCCURRENCE
<br />INSURED TTHOLD
<br />INSURER B:H meI n Insurance Company of New Y
<br />34452
<br />INSURER C '.Atlantic Specialty Insurance Compan
<br />27154
<br />Palermo TT Holdings, Inc.
<br />9477 Waples, Suite 100
<br />San Diego CA 92121
<br />INSURER D:RSUI Indemn ty Company
<br />22314
<br />INSURER E
<br />VIED EXP (Any one person)
<br />INSURER F
<br />PERSONAL A ADV INJURY
<br />$1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 660514944 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 />INSR
<br />LTR
<br />rypE OF INSURANCE
<br />ADDLSUBR
<br />INSR
<br />MD
<br />POLICYNUMBER
<br />POLICVEFF
<br />MMIDDNYY)
<br />POLICY EXP
<br />MMIDONYVY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />40348411336
<br />/1/2014
<br />/1/2015
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FTI OCCUR
<br />DAMAGE RETED
<br />PREMSESOEa occurrence
<br />$100,000
<br />VIED EXP (Any one person)
<br />$Excluded
<br />PERSONAL A ADV INJURY
<br />$1,000,000
<br />X 10,000 Dad
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGO
<br />$2,000,000
<br />POLICY PRO- X LOC
<br />$
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />7110125320003
<br />-C79M=INGLE LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANYAUTO
<br />X
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />$
<br />D
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />NHA235453
<br />/1/2014
<br />/1/2015
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS-MAOE
<br />DED I RETENTION$
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />4060371810003
<br />/1/2014
<br />/112015
<br />X WC SLAU OTH-
<br />ANY PRO PRI ETOR /PARTNER /EXECUTIVE❑
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(Mantlatory In NH)
<br />If yes, describe under
<br />DE SC RI PINION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />B
<br />Tech Professional Liab
<br />TPP106914
<br />/1/2014
<br />11/2015
<br />5,000,000 Each Claim
<br />Retroactive Date 1992
<br />5,000,000 Aggregate
<br />Claims Made
<br />25,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is red at red)
<br />City of Santa Ana its officers, employees, agents, volunteers and representatives is included as Additional Insured as required by written
<br />contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General Liability
<br />and Automobile Liability policies. \ r I
<br />' j��•;.t � u rezn
<br />City of Santa Ana
<br />60 Civic Center Plaza
<br />Santa Ana. CA 92701 -0000
<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 />no 19RR -2010 ACORn CORPORATION_ All rinhls
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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