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WOMEN -3 OP ID: LA
<br />.�` CERTIFICATE OF LIAEILIW INSURANCE DATE(MMIDDIYYYY)
<br />04/15/2015
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poliey(ios) must he endorsed.. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />INSURED
<br />Service
<br />Center, Inc.
<br />P,O, Box 6103
<br />Orange, CA 92863
<br />714.577.5800
<br />of CA
<br />COVFRAGFR CFRTIFICATF NIiMRFR- RFA/ICInm NI 1uunrp.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />NDC OaR POLICY NUMBER PdM Do `_ MOLDD YX`Il' LIMITS
<br />LTRIff TYPE OF INSURANCE wINNn
<br />A
<br />X
<br />COMMERCIAL GENERALLIABILITY
<br />Daniel Perez
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 1988 M-25
<br />Santa Ana, CA 92702
<br />�Vm/I
<br />EACH OCCURRENCE
<br />$- 1,000,000
<br />01.AIMS-MADEX OCCUR
<br />� X
<br />201401835NPO
<br />09/101/2014
<br />09/01/2015
<br />ABMG€ f $
<br />PR SES Ea ccerrence
<br />100,000
<br />MED EXP (MY on. person)
<br />$ 5,000
<br />No Ded
<br />I
<br />PERSONAL &AW INJURY
<br />$ 1,000,000
<br />_
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />X
<br />POLICY [:] d'EOT E] LOC
<br />PRODUCTS-COMPIOPAGG
<br />$� 1,000,000
<br />Emplo Ben
<br />$ Included
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />C5AR1NED SINGL I
<br />Eaident
<br />f0 cc
<br />$ 1,000,000
<br />A
<br />X
<br />ANY AUTO
<br />20140183SNPO
<br />09/0112014
<br />09101/2015
<br />BODILY INJURY (Per person)
<br />$
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per.6denl
<br />( )
<br />$
<br />X
<br />HIRED AUTOS I X AUOTOSWNED
<br />_
<br />Peramlden DAMAGE
<br />$
<br />X
<br />$500 Comp I X $1000 Coll
<br />$
<br />)(
<br />UMBRELLA LIAR X OCCUR
<br />E EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />EXCESS LIAa CLAIMS -MADE
<br />201401835UMBNPO
<br />09/01/2014
<br />09/01/2015
<br />AGGREGATE
<br />$ 1,000,000
<br />DEO I X I RETENTION None
<br />I
<br />Prod/Comp
<br />$ 1,000,000
<br />COMPENSATION
<br />I
<br />X R OTH
<br />STATUTE ER
<br />�
<br />B
<br />IWORKERS
<br />AND EMPLOYERS' LIABILITY
<br />PROPRIETORIPARTNERIEXECUTIVEY
<br />WC20140005441
<br />(
<br />03/28/201570312L812016
<br />�'$
<br />(ANY
<br />Y
<br />N/A
<br />EEACH ACCIDENT
<br />1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />E.L. DISEASE -EA EMPLOYE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OFOPERATIONS below
<br />EL DISEASE-11UUYLI1IT
<br />$ 1,000,000
<br />A
<br />Sexual Conduct.
<br />I
<br />201401835NP0
<br />09/01/2014
<br />09/01/2015
<br />Aggregate 1,000,000
<br />I
<br />I
<br />Ea Claim 1,000,000
<br />DESCRIPTION OP OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addlfionel Remarks Schedule, may be rdmolo d If more space is racelr d)
<br />City of Santa Ana; its officers, agents employees and volunteers are named
<br />as additional insureds as respects to the general liability policy limits
<br />CG2012 attached to the coverage
<br />per endorsement policy with primary and I
<br />non-contributory per endorsement NIAC1961 attached to the policy. Y
<br />C PPTIFIr.ATF Ifni OFR r`AMr`FI I ATInM
<br />CISANBE
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana-ESG M-25
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Daniel Perez
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 1988 M-25
<br />Santa Ana, CA 92702
<br />�Vm/I
<br />@ 1988-20'14 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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