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A� °® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />2/9i2o�6'DD"YY`'
<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 />Arthur J. Gallagher Co.
<br />Insurance Brokers of f CA. Inc. I # 0726293
<br />505 N Brand Blvd, Suite 600
<br />NAMEACT I Chan
<br />PHONE , 818 - 539 -2300 FAx , 818 - 539 -2301
<br />E -MAIL
<br />. Mei_Chan @ajg.com
<br />INSURER 5 AFFORDING COVERAGE
<br />NAIC #
<br />Glendale CA 91203
<br />INSURER A: River port Insurance Company
<br />36684
<br />101112015
<br />INSURED
<br />INSURERB:New York Marine And General Insuran
<br />16608
<br />Interval House
<br />P.O. Box 3356
<br />INSURER C:
<br />$100,000
<br />X
<br />MED EXP (Any one person)
<br />Seal Beach, CA 90740
<br />INSURER D
<br />Prof l.iab.
<br />INSURER E:
<br />INSURER F:
<br />SexualMlsconduct
<br />PERSONAL & ADV INJURY
<br />COVERAGES CERTIFICATE NUMBER: 611928704 REVISION NUMBER:
<br />THIS IS TO CERT #FY 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 />tTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDOIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />Y
<br />RIGOO147888
<br />101112015
<br />10/1/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTFD
<br />PREMISES Ea occurrence
<br />$100,000
<br />X
<br />MED EXP (Any one person)
<br />$5,000
<br />Prof l.iab.
<br />X
<br />SexualMlsconduct
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY ❑ PRO JECT F7 LOC
<br />GENERALAGGREGATE
<br />$3,000,000
<br />GEN'L
<br />PRODUCTS - COMPIOP AGG
<br />$3,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />MBINED SINGLE
<br />Ea ccident
<br />a
<br />$
<br />BOD I LY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Par accident)
<br />$
<br />HIRED AUTOS NON -OWNFD
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accidenl
<br />$
<br />A
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />RELOO14789
<br />10/1/2015
<br />10/1/2016
<br />EACH OCCURRENCE
<br />$2,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$2,000,000
<br />DED X I RETENTION $0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY FROPRIETORIPARTNEWFXECUTIVE
<br />OFFIC21MEMBER FXCLUDED7
<br />NIA
<br />WC201600005078
<br />21112016
<br />2/1/2017
<br />PER OT
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$11000,000
<br />E.L. DISEASE. EA EMPLOYE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />A
<br />A
<br />Crime/Employee Theft
<br />Forgery &Alteration
<br />rR 14788 8
<br />147888
<br />10!1!2015
<br />10/112015
<br />10/1/2016
<br />10/1/2016
<br />Deducilble: $1,000 300,000
<br />Deductible: $1,000 200,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS) VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Carrier A: Blanket Building Coverage Limit: $4,339,2001 Special Form/ Deductible $1,000 /effective 10 -01 -2015 to 10 -01 -2016
<br />Carrier A: Blanket Business Contents Limit: $530,0001 Special Form/ Deductible $1,0001 effective 10 -01 -2015 to 10 -01 -2016
<br />Contract # 2012 -050. City of Santa Ana, its officers, agents, employees and volunteers are named additional insured with respect to the
<br />General Liability policy of the named insured. Such insurance is primary and non - contributory. CG2026 Endorsement attached. Waiver of
<br />Subrogation for Workers Compensation policy applies in favor of certificate holder.- Endorsment to follow
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN/)
<br />City of Santa Ana Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Terri Eggers
<br />20 Civic Center Plaza, M -25 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 USA
<br />O 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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