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INTEHOU -03 VSSURESH
<br />'4 I1C7" L> CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 5/20 5 v)
<br />2/5/2015
<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 BYTHE 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the pulley, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder In Ileu of such endorsement(a).
<br />PRODUCER License # 0726293
<br />Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc.
<br />505 N Brand Blvd Suite 600
<br />Glendale, CA 91263
<br />0 AM
<br />TACT
<br />E:
<br />PHONE
<br />918 5382300 818 539.2301
<br />) Aro Nm: ( )
<br />-MA' IYL
<br />ADDRESS:
<br />INSURERS) AFFORDING COVERAGE
<br />NAG
<br />INSURER A:RiverportInsurance Company
<br />36684
<br />INSURED
<br />INSURER a; New York Marine And General Insurance Cc
<br />16608
<br />INSURERC:
<br />Interval House
<br />INSURER D;
<br />P.O. Box 3356
<br />Seal Beach, CA 96746
<br />INSURERS:
<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 />INTRR
<br />TYPE OF INSURANCE
<br />°
<br />PV N9
<br />POLICY NUMBER
<br />C F
<br />LI YE %P
<br />(MOM DO
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MAOE 1 7X OCCUR
<br />Prof Llab.
<br />X
<br />RIC0014071
<br />1010112014
<br />10/01/2015
<br />EACH OCCURRENCE
<br />$ 1,660,000
<br />PREMSES 2eoccurren as)
<br />$ 100,000
<br />X
<br />MED EXP (Any one arson)
<br />$ 5,000
<br />X
<br />Sexual Abuse
<br />PERSONAL B AOV INJURY
<br />$ 1,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ PEA 11 LOG
<br />GENERAL AGGREGATE
<br />$ 3,000,000
<br />PRODUCTS - COMP /OP AGO
<br />$ 3,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMB/ ED91 G LIMIT
<br />Ea accident
<br />$
<br />BODILY INJURY (Par person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />HIREDAUTp3 NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Perecddont
<br />) $
<br />PROPERTY DAMAO
<br />Per accident
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />X
<br />EXCESS LIAa
<br />CLAIMS -MADE
<br />REL0014072
<br />10101/2014
<br />10/01/2015
<br />AGGREGATE
<br />$
<br />DED I X I RETENTION$ 0
<br />Aggregate
<br />_
<br />2,000,000
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNEWEXECUTIVE YIN
<br />(Mandatory In NH)EXCLUDED7
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />X
<br />201500005079
<br />0210112015
<br />02(0112016
<br />X
<br />PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />E. L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Crime /Employee Theft
<br />RIC0014071
<br />10/01/2014
<br />10/01/2015
<br />Deductible: $1,000 300,000
<br />A
<br />Forgery & Alteration
<br />RIC0014071
<br />1010112014
<br />10/01/2015
<br />Deductible: $1,000 200,000
<br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORO 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />Contract # 2012 -050, City of Santa Ana, its officers, agents, employees and volunteers are named additional Insured with respect to the General Liability
<br />policy of the named insured. Such Insurance is primary and non - contributory. CG2020 Endorsement attached. Waiver of Subrogation for Workers
<br />Compensation policy applies in favor of certificate holder: Endorsment to follow
<br />Carrier A: Blanket Building Coverage Limit: $4, 339, 2001 Special Form I Deductible $1,0001 effective 10.01.2014 to 10-01 .2015
<br />Carrier A: Blanket Business Contents Limit: $530,0001 Special Form / Deductible $1,0001 effective 10 -01 -2014 to 10-01 .2015
<br />i
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Community Development Agency
<br />Attm Terri Eggers
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Cantor Plaza, M•25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />'hP� 1%
<br />p 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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