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211OC -0000 HBCT21 <br />�.' CERTIFICATE OF LIABILITY INSURANCE <br />OATS �YYYY) <br />2120 <br />21212016 <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 doe's not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />PRODUCER License # 0564249 <br />CONTACT Jackie Riola. ._. <br />NAME: <br />Heffernan Insurance Brokers <br />PHONE FAX( <br />(Arc, Na, Ext): 1 (714) 36'1 -7700 (AiC, No): 1 {714) 361 -7701 <br />6 Hutton Centre Drive, Suite 500 <br />Santa Ana, CA 92707 <br />E -MARL <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE. NAIL # <br />INSURER A:Nanprofits Insurance Alliance of California 01184 <br />INSURED <br />INSURER B.: QBE Insurance Corporation 39217 <br />2 -1 -1. Orange County <br />INSURER C <br />1505 E. 17th Street <br />Suite 1108 <br />INSURER „D : ........ -_ .... _... <br />Santa Ana„ CA 92705 <br />INSURER -E <br />INSURER F <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 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 />_ ..... .... <br />INSIR ADDL.SUBR POLICY EFF POLICY EXP _ _. .......... ... <br />LIMITS <br />.TYPE OF INSURANCE. INSD VYVD POLICY NUMBER POLICY (MMIDDNYY yj <br />—.. _M..u. <br />.A �...X <br />_..m.__ __ <br />._ : EACH OCCURRENCE �_.$__..�. 1,000,000 <br />COMMERCIAL GENERAL LIABILITY <br />CLAIM OCCUR .s -MADE X X 201603104NPO 0210112016 02/0112017 DA�iAGETORENTED <br />-_ -.. PREMISES (Ea,occurrence) $ ........ 500,000 <br />ME EXP IAny one person) S 20,000 <br />.. _ -. ....... ........ PERSONAiL. & ADV INJURY S 1,000,000... <br />....... <br />GFN'L AGGREGATE LIiMITAPPLIE$ PER GENERAL AGGREGATE 2,000,00'0 <br />POLICY __... PRO ( X LOC '... PRODUCTS...- ...COMP /OR AGG S _ -.. 2,000,000 <br />OTHER:^ <br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1 OQ0 :0Q.4 <br />(Ea acciderI)_. <br />A ANY AUTO 201603104NPO 0210112016 02/01 /2017 BODILY INIJURY IPer person) S <br />_ ALL OWNED _.. SCHEDULED _...... ...... _. <br />AUTOS AUTOS BODILY INJURY (Per accident) S <br />NON -OWNED <br />X X PROPERTY DAMAGE S <br />HIRED AUTOS accident) <br />AUTOS (Per - _ <br />S <br />;.. X UMBRELLA LIAB X OCCUR EACH OCCURRENCE ........._._..S 2,000.,000 <br />A EXCESS LIAB CLAIMS -MADE 201603104UMBNPO 02101/2016 02/0112017 AGGREGATE 2,000,000 <br />- <br />DED RETENTION <br />WORKERS COMPENSATION OTH <br />STATUTE <br />AND EMPLOYERS' LIABILITY YIN _ _.. . ER <br />ANY PROPRIETORrPARTNER]EXECUTIVE E.L. EACH ACCIDENT S <br />OFFICER/10 MBER EXCLUDED? NIA - -. _ .... ....... <br />(Mandatory in NH) E...L. DISEASE - EA EMPLC'YEE S <br />If yes, describe unldea <br />DESCRIPTION OF OPERATIONS belew E,.L. DISEASE - POLICY L6MIT S <br />B Disability- AD&.D -Trav MHH010307 02/0112016 0210112017 50,000 <br />A Prof. Liability 201603104NPO 02/0112016 0210112017 Ea. Occurance 1,000,000 <br />DESCRIPTION OF OPERATION$! LOCATIONS I VEHICLES (ACORD 101.,, Additionei Remarks Schedute, may be attached if more space is required) <br />Re: As Per Contract Or Agreement on File With Insured. City of Santa Ana, Community Development Agency is included as an additional insured on General <br />Liability policy per the attached' endorsement, if required. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Community Development Agency. <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Administrative Services Division M -25 <br />AUTHOR &ZED REPRESENTATIVE <br />2'.0 Civic Center Plaza <br />Santa Ana, CA 92701 <br />' <br />Q 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />9 <br />