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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM /DDNYYY) <br />4/14/2016 <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 CE Iy IFIC' 1{�lQDER <br />IMPORTANT: If the certificate holder is an ADDITI A LINSUR , tHlf 1611dy(ie 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).. " y }c: r .. - <br />PRODUCER 1 ,A <br />United Agencies, Inc. ,L 1�1 <br />One Post, Ste. 200 <br />Irvine CA 92618 <br />CgNTA;.T <br />NAME: <br />ada <br />PHONE FA% <br />- - A Nat: <br />E -MAIL <br />ADDRESS: <br />INSURERS AFFORDING COVERAGE <br />NAIC If <br />60475294 <br />INSURER A: United 'r <br />4/6/2017 <br />EACH OCCURRENCE <br />INSURED DEKRI N D -01 <br />INSURER B <br />X COMMERCIAL GENERAL LIABILITY <br />INSURERC: <br />Dekra -Late Industries, Inc. <br />3102 W. Alton Ave <br />Santa Ana CA 92704 <br />INSURER D <br />A E T Ea oc currence) oc ED <br />PREMISES <br />$1170,000 <br />MED EXP tAn y one person) <br />$5,000 <br />INSURER E : <br />CLAIMS -MADE IX I OCCUR <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: P34359gaR 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />ADDLSUBR <br />INSR <br />me <br />POLICVNUMBER <br />POLICVEFF <br />MMIDDNYYV <br />POLICY EXP <br />MMIDONYYY <br />LIMITS <br />• <br />GENERAL LIABILITY <br />60475294 <br />4/8/2016 <br />4/6/2017 <br />EACH OCCURRENCE <br />$1,000,000 <br />X COMMERCIAL GENERAL LIABILITY <br />A E T Ea oc currence) oc ED <br />PREMISES <br />$1170,000 <br />MED EXP tAn y one person) <br />$5,000 <br />CLAIMS -MADE IX I OCCUR <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />GENERAL AGGREGATE <br />$2,00D,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP ADD <br />$2,000,000 <br />POLICY PRO- LOC <br />$ <br />• <br />I AUTOMOBILE <br />LIABILITY <br />60475294 <br />4/8/2016 <br />4/8/2017 <br />COMBINED SIN7D!T7VT_ <br />Ea accident <br />$1,000,000 <br />BODILY INJURY (Par person) <br />$ <br />X <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />X <br />NO%OWNED <br />HIRED AUTOS X AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />Leased /Rented Autos <br />$ACV <br />• <br />X <br />I UMBRELLA LIAR <br />OCCUR <br />60475294 <br />418/2016 <br />418/2017 <br />EACH OCCURRENCE <br />$2,000,000 <br />AGGREGATE <br />$2,000,000 <br />EXCESS LAG <br />CLAIMS -MADE <br />DED X RETENTION$ 10,000 <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />N <br />WC STATU- OTH- <br />1 <br />E.L EACH ACCIDENT <br />$ <br />ANY PROPRIETOR/PARTNEWEXECUTIVE❑ <br />OFFICE RIMEMBER EXCLUDED? <br />NIA <br />EL. DISEASE - EA EMPLOYE <br />$ <br />(Mandatory in NH) <br />If yes, describe under <br />E.L. DISEASE - POLICY LIMIT <br />$ <br />DESC RIPTION OF OPERATIONS below <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlr.d) <br />The City of Santa Ana , its officers, elected or appointed officials, employees, agents and volunteers are to be specifically named and <br />covered as Additional Insureds by the attached forms, but only as required by written contract with the named insured prior to an <br />occurrence, Subject to all policy terms & conditions. Re- Ili1ew C.69 6 <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana CA 92701 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />no 1988 -2010 ACORD CORPORATION. All Hrthts <br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD <br />