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1416 -
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MM/OU/ Y
<br />DBMa y6YYY)
<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(les) 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 endorsement(s).
<br />PRODUCER
<br />Ann Risk $et'Vi CeS Northeast, Inc.
<br />New York NY Office
<br />199 Water Street
<br />New York NY 10038-3551 USA 9 S L_ ry / '
<br />e IJ
<br />CONTACT
<br />NAME:
<br />PHONE(866) 283-7122 FAX
<br />(Plc No,), (900) 363-0105__
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(a) AFFORDING COVERAGE NAICYI
<br />INSURED
<br />SCF Jones & Stokes, Inc.
<br />9300 Lee Highway
<br />Fairfax VA 22031-1207 USA
<br />INSURERA: Great Northern Insurance Co. 20303
<br />INSURER B: Pacific Indemnity CO 20346
<br />INSURER C: AXIS surplus Insurance Company 26620
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER- 570058998501
<br />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, Limits shown are as requested
<br />LTR
<br />TYPE OF INSURANCE
<br />1 SL
<br />Me
<br />POLICY NUMBER
<br />P D OLICY FF
<br />M0 0 Y
<br />LIMITS
<br />X COMMERCIAL GENERALLIAfflUTV
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE % OCCUR
<br />Package - Domestic
<br />i •D $1,000,000
<br />PaEMIS,F$.(Ea aocurmnso)
<br />MED EXP (Any one Person) $10,000
<br />X Cenlrecloel Liability
<br />PERSONAL A ADV INJURY $1,000,000
<br />GEN'LAGGREGATE LIMITAPPLIES PER:
<br />GENEMLAGGREGATE $2,000,000
<br />X POLICY DPRO- ❑ LOO
<br />JECT
<br />PRODUCTS- CCMPIOPAGG $2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />7352-29-55
<br />Automobile - All States
<br />06/25/201507/01/2016
<br />COMBINED SINGLE LIMIT $1,000,000
<br />IS. aeeld.rl
<br />BODILY INJURY (Far roman)
<br />X ANYAUTO
<br />BODILY INJURY (Per accident)
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X HIREDAUTOS X
<br />AUNON-OWNED TOS
<br />PROPERTY DAMAGE
<br />Por aacldenl
<br />UMBRELLALIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEP RETENTION
<br />e
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR? PARTNER I EXECUTIVE N
<br />71-75-41-37
<br />Workers Comp
<br />0 / 5/2 1
<br />-O 25/2016
<br />% I PER STATUTE I o7H.
<br />E
<br />E.I. EACH ACCIDENT $1,000,000
<br />OFFICEMMEMSER EXCLUDED?
<br />?Mandatory in Mn
<br />NIA
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />0yos, desedbe ender
<br />DEa RIPTION OF OPERATIONS 1,0.
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />o
<br />E&O-MPL-Primary
<br />ESZ768043/01/2015
<br />06/25/2015
<br />07/01/2016
<br />Prof Liab Agg - All 110001000
<br />Errors & Omissions
<br />Overall policy aggrl $1,000,000
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (ACORD 101, Addlllorel Remarks Sehadele, may be allaehed It more aryace is ragolrod)
<br />1 - Professional Liability is a Claims Made policy. There is no Additional Insured status on the Professional Liability
<br />coverage.
<br />2 - The City of Santa Anal its officers, employees, agents, Volunteers and representatives are included as Additional Insureds
<br />as respect General Liabillty. r p/ )'%
<br />" 'ci/t a ��i� 7 Y
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana AUTHORIZED REPRESENTATIVE
<br />c/o Clark of the Council
<br />20 Civic Center Plaza,
<br />P.O. Bax 1988 fy/f iJJ/C62.eiraciY.rcucTZ` �za
<br />Santa Ana, CA 92702-1988 USA n.14F"osL c/o ,fO
<br />(719802014 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2014101) The ACORD namo and logo are registered marks of ACORD
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