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<br />M G' GATE IMNJQOIYYY
<br />CERTIFICATE OF LIABILITY INSURANCE YI
<br />baewm/ 5/19/2015
<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), AUTHORIXED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certlPicate holder [San ADDITIONAL INSURED, the poiny(les) must ba 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 rlghts to the
<br />PaODUCER
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER
<br />w.r
<br />:Dana Martin
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />All -Cal 2nsurance Agency
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />_
<br />PHONERnfl (916 )784 9070 ��NI 19167
<br />Tea•UrGe
<br />Vexnan Street
<br />1.505
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<br />INSURER(B) AFFORDING COVERAGE
<br />NAIC B
<br />Roseville CA
<br />9.567E
<br />INSUREDNDnprOiltB Ins�tiranoe Alliance of
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<br />INSURED
<br />GEMrRAL 1GGREGAT-- I..-- _, _2 ., - - ,
<br />INsul:eR aB kat;e Comgensataon Insurance Bund
<br />;35076
<br />Los Angeles Dria"I 9klapaxe
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<br />DIER'
<br />COMBINED SIG h1 f S 1 OD0,000
<br />P.O. Hax 3831
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<br />ANY AUTO
<br />,INSURER F. ..,...... _.._.._.__. .................
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<br />Orange CA
<br />92565
<br />INOURIER P:
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<br />r cnncrry nre M1UmAcirR.rti. B91.3n451. 0REVISION NUMBER:
<br />UMBRELLALIAD mm OCCUR
<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
<br />DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
<br />INSq _..,_.. ,. ... ......,_... -..... ADOL Shea..__ _. ... ....... POLIDY EEK PpLICY di�pp
<br />LIMITS
<br />LTR TYPO UP INSUFANCE INTQ v<M POLICYNUMBEft IMMIODttYYYI'(MIdIBMIYYYI
<br />X COMMERCIAL GENERAL LIABILITY - -
<br />BEACH OCCURRENCE ,S 1,000, OOb
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<br />- PREMISES(.. lwra SOD,9Do
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<br />A CLAIMSUMAOE X OCCUR I I
<br />PREMISES IE C cyrrpOca)
<br />X LTQVOR LIARTLSTY x 2015-OB609MP0 16/13/201516/13/2016
<br />MEO EXP (Arty anapxso) r3 20000
<br />.....
<br />$ 1 000,000 / 1,000,000 I
<br />PERSONAL&ADVINJURY ,3 1 009 000
<br />GEN-LAGGREOATE I.IPAITAPPLIE9 PER:
<br />GEMrRAL 1GGREGAT-- I..-- _, _2 ., - - ,
<br />.i POLICY PRO. Opt; '
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<br />PRODUC I3 COMP/OP AGG 1 $ 2,000,000
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<br />DIER'
<br />COMBINED SIG h1 f S 1 OD0,000
<br />AUTOMOBILE LIABILITY
<br />([a eC4Ytl N)
<br />IS
<br />..,.
<br />BODILY INJURY (Per Po I
<br />ANY AUTO
<br />ALL OVINUO SCHEDULED 2015-03604NPo 6/13/2015 6/13/2016
<br />DODILY INJURY (Per ecclden)S
<br />AUTOS .. .AUTOS
<br />pRDPERTYbAMAGE ' 5
<br />X HIRED AUTOS X.. pDTO9lEU
<br />.
<br />mm
<br />5
<br />UMBRELLALIAD mm OCCUR
<br />- EACH 0 -CCU RRENCE _3
<br />.E%CE99 LIAB f CLAIMe.MADE'� I
<br />AGGREGATE ........ IS
<br />UEp RETENTION
<br />3
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<br />X al I
<br />STAT{ITE
<br />WORNERSCOMPENSATION I
<br />" .�..,_ - - -
<br />AND eMPLOYER6' LIABILITY •I I N I -
<br />ANY PROPRIErORIPARTNERIEXECUTIVE "".,
<br />E,LEAGHACOIDF,NT_ 15 y1. 000,000
<br />IAS
<br />OFFIC$ (Mantlafarry 6{NHj EXCLUDED? e0'1BO2T-13 I,- 6/6/2015 6(6/2016
<br />E,L, BISEA9E• EA EMPLOYEry-8 .. 1,000,000-
<br />If yes, tleev,he under, +
<br />0E3CRIPTION OPERATIONS
<br />'bcicx .„.,_—
<br />,E,L DISEASE POLICY LIMI7;S 1,000,000
<br />DESCRIPTION OF oPERA'RONS I LOCATIONS I VEHICLES (AGGRO 101, Addlllenal R"r,l a 9elVIa410,,>MY he ottnhetl if II epee Is Rqu0utl)
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED ADDITONAL INSURED UNDER
<br />THE TERMS OF THEIR CONTRACT, INSURANCE IS PRIMARTY AND NONCONTRIBUTRY.
<br />FORM CG 20 10 APPLIES
<br />CITY OF SANTA ANA
<br />ATTN: PURCHASING DEPARTMENT
<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 BC DELIVERED IN
<br />ACCORDANCE WITFITHE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />l..C.14c
<br />Z-
<br />@
<br />J 1988-2014
<br />ACORD 26 (2014101) The ACORO name and logo are registered marks of ACORD
<br />1NS025 (20141
<br />reserved.
<br />
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