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I4ARRIS&ASS 0ClATEu RFCA 314115AGR ft TBD REVIEWED BY: '` '` ,`S^` FUNICE HEREDIA l OF 11)
<br />CERTIFICATE ®F LIABILITY" IN URANCE G8/R`MIDD,YYYYI
<br />�w,,,,/ 00)25/2015
<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(Sh AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
<br />IMPORTANT: If the cortifloote 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 0757776 1.-800-877-4560
<br />HUB Tnearnal'ianxl insurance services Inc.
<br />CONTACT
<br />NAME: ,....._ _......,.,_. _
<br />PHONE 925 609-6500 P' 925 609-6550
<br />._ AIG, La}: -
<br />P.O. Btl% &047
<br />ADDRL -'- "-"
<br />ADDRESBt
<br />Concord, CA 94524
<br />_,,,,,,__._-,-_ INSURER(S)AFFORDItIOCDVERAGE NAICR
<br />Citizens Insurance COoaaY of Amasica
<br />INSURERS m
<br />........ ............ _ ..__.._..__ ___.�„_,._.
<br />INBUREO
<br />Petrie & Associates Inc.
<br />Attn,, Susan Mandllag
<br />1401 Willow Pass Road, Suite 500Continental
<br />INSURERB: Navigetore Specialty Insurance Company
<br />ttlsuRaRc, Travel arc,Pl,operty Casualty CO of Amer_„
<br />Casualty Company
<br />.INSURER D: Y H Y
<br />06/01/16
<br />INSURERS:
<br />$2,DDD,ODD
<br />Concord, CA 94520
<br />BE�.�.. .._._�....
<br />B Sect 0
<br />THIS IS TO CERTIFY THAT TFIE POLICIES OF INSURANCE LISTED ©GLOW hIAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR '['HE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TFIN
<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 DY PAID CLAIMS,
<br />�Sft
<br />LTR
<br />_. __,._...,....___
<br />TYPE OF INSURANCE
<br />D
<br />p
<br />&YB
<br />.._......__
<br />pOLICY NUhiDER
<br />POUCEFY Fpo
<br />! MMDONYYY
<br />UCYEXP
<br />M IDEYYYY
<br />LIMITS
<br />_
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIALOEN RA.LLIABILLY
<br />CLAIMS MADE OCCURsrsnZ
<br />:±ants And, CA 92701
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<br />EaF9201722
<br />p8/Ol/1
<br />06/01/16
<br />E\CII011IRRENOE
<br />$2,DDD,ODD
<br />dulls -Si o,1U
<br />RHP (Any nen
<br />,$1, ODD, 000
<br />$10,000
<br />B Sect 0
<br />ACV
<br />PERSONAL ° 'V BjI R'l
<br />� $2,000,000
<br />NERALAt CR GATE
<br />4, 000 000
<br />GEWL AGGREGATE LINiIf APPLIES
<br />�a
<br />PRUDU f CUIVIPiOP ACC
<br />F -t
<br />(she ODO 0D0
<br />POLICY X � `CT
<br />..—
<br />_
<br />AUTCMODRn
<br />LIABILITY
<br />COMBINED SNULE LIMIT
<br />_.._.
<br />ANY AUTO
<br />Portly MANY r, I WP 1
<br />�
<br />AUL ORDER 6OHtDULEO
<br />AUTOS IAUTOS
<br />NON U4VNEo
<br />HIRED At 0
<br />I
<br />i
<br />BODILY INtJVPY ran gd§lt)�p
<br />PROPE"IfY DAN AGE
<br />S
<br />a
<br />UMORELLA LIAa X
<br />I
<br />OCCUR
<br />LAn 58=7127 01 2C
<br />-
<br />08 01 1,
<br />/ /
<br />03/01/16
<br />FA(�Ctfi Dl{t NCE
<br />(310, C00, 600
<br />R
<br />EXCESS BAR.'
<br />CIAIM>MADE!
<br />!
<br />ACGREGA,E
<br />....... `
<br />I$70,0D 0,000 _.....
<br />-„_
<br />DID X I RETFD IONS
<br />C
<br />WORKERS OOMPCNATION
<br />AND EMPLOYS R9 NADIUTY 'f l N
<br />ANY PROIRETO}IPA%l NERIEXECUSiVE❑
<br />0HFCERIMLUBC Y, tCIUDLDp N
<br />(Mandatory in NH)
<br />R1/11,11,11 ULinr
<br />ArIPTION Of OPERATIONS L,Oow
<br />NiA
<br />7PJLn181.66N35A15 '++
<br />O8/D1/1
<br />06/01/16
<br />I
<br />MI AST7U'``'�
<br />LTt,aznilie itis)... J Ems_
<br />EL. EAC 1,1 ACGIDEP9
<br />EL, Dle[AS CA EivIPLOYCF
<br />_ -
<br />IE 1,000,000
<br />T_
<br />1,000,000
<br />EL OIGEABE-POLICY LIMIT
<br />....•_.— -
<br />51, D00, 000
<br />_
<br />D'OPT6S'1J`TIONAL
<br />LIABILITY
<br />_
<br />AEH59189158E1 ----
<br />C8,7017r
<br />00 01 1G
<br />Per Claim: 5,0'a, Yb00
<br />Claims -Mad.
<br />Aggragat e: 10,000,000
<br />Dad. Each Clain: 150,000
<br />DESCRIPTION 0' OPERATIONS I LOCATIONS) VEHICLES (Altus, ACORD nlf ArldIRIORl ReL:.Sm sd,.dulc, II morn 1,1. is ruqulml)
<br />** Workers Compensation policy excludes monopoli8ti0 States ND, 011, PIA, WY,
<br />General Llabili Ly Addi Lior,al Insured status granted, iP required by ilmi,tten contract/agreement, per attached 5orme
<br />ICAN 8426 a MAN 0427.
<br />The city of Santa Ana, its dfficaxs, employoas, agents G rapseaeutativas xra allditional 1a6ureds under General Giabilit
<br />if required by a written contract
<br />RE: Vendor Application
<br />U LK I IPIGA I L HE LUL-iN CAAICFI I aTU1N
<br />Vendor Application (2015)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />C i.Cy of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREO In
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Purchasing COPE,
<br />_
<br />2C; Civic Center Plate
<br />AU'I'NORIZEp REPRESENTATIVE mm
<br />:±ants And, CA 92701
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<br />-- i,.,_..,......�........�-.-n.-...._.. 4J�3A
<br />c1L'I3na-2010 AGUKU t;oRIURATiON. All rights reserved.
<br />ACORD 25 (2090!05) "I "he ACCRD nallte and tov arc registered (narks of ACORD
<br />amanriilag
<br />
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