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COLE &HOC. dba COLE DESIGN GROUP AGR# TED PROJ. 166852 REVIEWED BY:" p!i �. EUNICE HEREDIA (PG 1 OF 4)
<br />ACt7RO® CERTIFICATE OF LIABILITY INSURANCE
<br />11,. "
<br />DATE (2015 YVVV)
<br />06/29/2015
<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(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 endorsement(s).
<br />PRODUCER
<br />NAME'.
<br />Marsh Sponsored Programs
<br />a division of Marsh USA Inc.
<br />701 Market Street, Ste. 1100
<br />PHONE FAX
<br />AIC Nc Ext:800- 338 -1391 LAIC, NO:888- 621 -3173
<br />E -MAIL
<br />ADDRESS: aceccl ientreques t @marsh. ccm
<br />INSURERS AFFORDING COVERAGE
<br />NAICIt
<br />St. Louis MO 63101
<br />INSURERA: Sentinel Insurance Company Ltd
<br />11000
<br />EACH OCCURRENCE
<br />INSURED
<br />Cole & Associates, Inc
<br />INSURERS: Hartford Underwriters Insurance
<br />30104
<br />Prof. Liab. Excl.
<br />INSURER C,
<br />401 S. 18th Street, Ste. 200
<br />St. Louis, MO 63103
<br />INSURER D:
<br />INSURER E:
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />S
<br />MD
<br />POLICY NUMBER
<br />POLICY SEE
<br />MM /DDIYYVV
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />y
<br />84SBWE04701
<br />04/15/2015
<br />04/15/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />Prof. Liab. Excl.
<br />DAMAGE TO
<br />PREMISESEer oaurrence
<br />$1,000,000
<br />CLAIMS -MADE 1XI OCCUR
<br />MED EXP(Any one parson)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER',
<br />PRODUCTS - COMPIOP AGO
<br />$2,000,000
<br />POLICY X JE OT LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />y
<br />84UEGKV6439
<br />04/15/2015
<br />04/15/2016
<br />COMBINED SINGLE LIMIT
<br />Eeacoident
<br />$1 000 000
<br />BODILY INJURY (Per person)
<br />S
<br />ANY AUTO
<br />ALL OVMdED X SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />S
<br />PROPERTY -DAMAGE
<br />fPeracCdentl
<br />$
<br />_
<br />X
<br />_
<br />HIRED AUTOS X NON-OWNED
<br />AUTOS
<br />s
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />84SBWE04701
<br />04/15/2015
<br />D4/15/2016
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEAD X I RETENTIONS 10 000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />84WBGBQ1579
<br />04/15/2015
<br />04/15/2016
<br />WCSTATU- OTH-
<br />X OBY LIMITS ER
<br />ANYPROPRIETORIPARTNERIEXECUTIVE❑
<br />E L. EACH ACCT DENT
<br />$1,000,000
<br />OFFICERNEMBER EXCLUDE-D9
<br />NIA
<br />EL. DISEASE- EA EMPLOYEE
<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 $1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
<br />The City of Santa Ana, it's officers, employees, agent., and representative are included as additional insured for the
<br />above coverage's except WC when required by written contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />01988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<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 />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />S
<br />20 CIVIC CENTER PLAZA, P.O. BOX 1988 M -16
<br />SANTA ANA, CA 92702
<br />01988 -2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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