INSTITUTE OF RISK AND SAFETY ANALYSES-2015

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ACbJZ ® CERTIFICATE OF LIABILITY INSURANCE '1 F DATE(MMIDDIYYYY) 1 10/21/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LEW Insurance & Financial Services, Inc. 28055 Smyth Drive y N-2015165 Valencia CA 91355 CONTACT Doreen Adelman NAME: PHONE E (661)702-6000 NC (661) 702-6060 -MAIL dor.ena@lbwinsurance.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A:Sentinel Ins. Co. LTD 11000 INSURED INSTITUTE OF RISK & SAFETY ANALYSES LAERATORY OF RISK & SAFETY ANALYSES, INC. 5329 CANOGA AVE WOODLAND HILLS CA 91369 INSURER B: Hartford Accident & Indemnity 22357 INSURER C: INSURER D: INSURER E: 1 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 CERT GL+AUTO+WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS AUTHORIZED REPRESENTATIVE X COMMERCIAL GENERAL LIABILITY P APD AS TO FORM Doreen Adelman/DOREEN EACH OCCURRENCE $ 2,000,000 A CLAIMS -MADE ❑X OCCUR ERENTED PREMISESS Ea occurrence $ 1,000,000 PREMI MED EXP (Any one person) $ 10,000 72SBALX0745 9/25/2015 9/25/2016 PERSONAL &ADV INJURY $ 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 X POLICY JjE� r7 LOC PRODUCTS - COMPIOP AGO $ 9,000,000 Policy Fee $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 BODILY INJURY (Per person) $ E ANY AUTO ALL OWNED SCHEDULED AUTOS 'Y AUTOS 720ECPX9333 10/27/2015 10/27/2016 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peraccident NON -OWNED HIRED AUTOS AUTOS - Metlical P.ment. $ 5,000 UMBRELLA UAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION ANDEMPLOYERS' LIASILITV YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA 72w CXN5282 8/16/2015 8/16/2016 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe antler DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, may be attached if more space Is required) The City of Santa Ana, 20 Civic Center Plaza, Zanta Ana, CA. 92701; It's officers, employees, agents, volunteers and representatives are named as additional insured, but only as respects to the liability arising out of their interest in property occupied by the named insured. Provisions for additional insured are outlined in the above referenced general liability policy and only apply when required by written contract. *10 day notice of cancellation for non-payment of policy premium. CERTIFICATE HOLDER CANCELLATION ` � , ` © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) S )aIMPWFSX&vMara�9 @66%re registered marks of ACORD INS025 (?mn nio anr Assistant City Attorney SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE P APD AS TO FORM Doreen Adelman/DOREEN ` � , ` © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) S )aIMPWFSX&vMara�9 @66%re registered marks of ACORD INS025 (?mn nio anr Assistant City Attorney