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<br />J
<br />271963
<br />AC"Rc�® CERTIFICATE OF LIABILITY INSURANCE
<br />DA10/27I2DIYYYY)
<br />10/27/2015
<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(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
<br />Commercial Lines - (818) 464-9300
<br />Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408
<br />CONTACT
<br />NAME:
<br />PHONE FAX
<br />AIC No Ez[: Are, No:
<br />EMAIL
<br />ADDRESS:
<br />15303 Ventura Boulevard, 7th Floor
<br />INSURERISI AFFORDING COVERAGE
<br />NAIC a
<br />Sherman Oaks, CA 91403-3197
<br />INSURER A; Federal Insurance Company
<br />20281
<br />INSURED
<br />INSURER e: Employers Insurance Company of Wausau
<br />21458
<br />DMA Claims, Inc.
<br />INSURER C:
<br />MED EXP (Any one person) $ 10,000
<br />330 North Brand Boulevard, Suite 230
<br />INSURERD:
<br />INSURER E:
<br />Glendale, CA 91203
<br />INSURER F:
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 9/41491 RFVISION NIIMRFR•. Seehelow
<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 />ILTR
<br />TYPE OF INSURANCE
<br />AODLSUBR
<br />JIM
<br />WFID
<br />POLICY NUMBER
<br />MPOLICY EFF
<br />MIODIYYYY
<br />POLICY EXP
<br />MMIDDIYYYv
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LI ABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />35809642
<br />02/10/2015
<br />02/10/2016
<br />EACHOCCURRENCE $ 1,000,000
<br />AGE ORE TED
<br />PREMISES Ea occurrence $ 1,000,000
<br />X
<br />MED EXP (Any one person) $ 10,000
<br />Dad: NII
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE S 2,000,000
<br />GEN'L
<br />X
<br />POLICY D PRO- ❑
<br />ECT LOC
<br />PRODUCTS-COMPIOPAGG $ Included
<br />$
<br />OTHER'.
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE_LM IT $
<br />Ea accident
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Persmidenl
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I RETENTION$
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? N7
<br />NIA
<br />WCCZ91438183015
<br />EVIDENCE ONLY
<br />7/1/2015
<br />7/1/2016
<br />X i STATUTE ETH
<br />E.L EACH ACCIDENT $ 1,000,000
<br />EL DISEASE -EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH)
<br />If ryE, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />EL DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />Errors & Omissions/Cyber Liab
<br />82250149
<br />02/10/2015
<br />02/10/2016
<br />55,000,000
<br />$50,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Rama rim Be middle, may be attached if more space is required)
<br />Certificate Holder is named as Additional Insured for General Liability only as respects operations of the Named Insured. Subject to policy terms,
<br />conditions, limitations and exclusions.
<br />HOLDER
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Cit Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE �1
<br />The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORD CORPORATION. All righ is reserved.
<br />ACORD 28 (2014/01) �-�/A
<br />Ims oenma,a,agaa� aAn�mw ernnae lAam ormzrrenlN U
<br />q� N o"I;LP. 13
<br />
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