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EPICLAN-01 ROSEM
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />�••-�`"
<br />DATE 1
<br />1013/2016
<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 INSURERS), 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 License # 0E67768
<br />IOA Insurance Services
<br />4350 La Jolla Village Drive
<br />Suite 900
<br />CONTNAME: Dana Schwartz
<br />PHONE,AX
<br />IC No Ext : (619} 574.6223 50203 AIC, No
<br />At DRIE ss: Dana,Schwartz@iaausa.com
<br />San Diego, CA 92122
<br />INSURER(S)AFFORDING COVERAGE
<br />NAIC q
<br />INSURER A: Valley Forge Insurance Company
<br />20508
<br />INSURED
<br />INSURER a: Transportation Insurance Company
<br />20494
<br />Epic Land Solutions
<br />2601 Airport Drive Suite 115
<br />INSURER C : American Casualty Company of Reading, Pennsylvania
<br />20427
<br />INSURER D: Underwriters at Lloyd's London IL)
<br />15792
<br />INSURER E :
<br />Torrance, CA 9D505
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS IS TO CER`I'IPY `rHAI" 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 />A
<br />SO
<br />R
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY E
<br />MM/DD(YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACHOCCURRENCE
<br />$ 2,000,000
<br />X CLAIMS -MADE OCCUR
<br />K
<br />4031022263
<br />10/0112016
<br />10101l2017
<br />PREMISES Ea occurrence
<br />$ 1,000,000
<br />X
<br />MED EXP (Any one person)
<br />$ 10,000
<br />Cont Liab/Sev of Int
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />GEML
<br />POLICY ❑X JECT LOC
<br />PRODUCTS •COMPtOPAGG
<br />$ 4,000,000
<br />$ 0
<br />OTHER:
<br />I
<br />IDeductible
<br />AUTOMOBILE
<br />LIABILITY
<br />NED NGLE LIMIT
<br />COEa acM8cWantI
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />ANY AUTO
<br />4031022253
<br />1010112016
<br />10/01/2017
<br />X
<br />X
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS N AUTOS
<br />Autos' Owned
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />X
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 6,000,000
<br />AGGREGATE
<br />$ 6,000,00
<br />B
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />6014253989
<br />10101/2016
<br />1010112017
<br />DED I X I RETENTION $ 0
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y
<br />ANY PROPRIETOR/PARTNCR/EXECUTIVC ❑
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />NIA
<br />594617867
<br />10/0112016
<br />10/01/2017
<br />X PER OT
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE • EA EMPLOYE
<br />$ 1,000,000
<br />If Yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E,L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />Prof LiablClms Made
<br />PGIARK06632-00
<br />1010112016
<br />10/0112017
<br />Per Claim 3,000,000
<br />D
<br />Ded.: $25k Per Claim
<br />PGIARK06632-00
<br />10101/2016
<br />10/0112017
<br />Aggregate 4,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, maybe attached If more space Is required)
<br />Re: All Operations
<br />City of Santa Ana, its offciers, employees, agents, volunteers and representativs are Additional Insureds with respect to General Liability per the attached
<br />endorsement as required by written contract. Insurance is Primary and Non -Contributory.
<br />30 Days Notice of Cancellation with 10 Days Notice for Non -Payment of Premium in accordance with the policy provisions.
<br />REVit-VVEt7 EiY EUNiC E HEREDIA (PG 6 OF )
<br />CERTIFICATE HOLDER CANCELLATION
<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 />20 Civic Center Plaza (M-21)
<br />P.O. Box 1988
<br />_T_ IJ
<br />1 ©t�
<br />Santa Ann, CA 92702
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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