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IBI GROUP RFCA 11/3/15 AGR dF PENDING REVIEWED BY:
<br />Z�..,_ ' EUNICE HEREDIA (PG 1 OF 8)
<br />AcoRIJ CERTIFICATE OF LIABILITY INSURANCE
<br />1.,,0•-
<br />DarE (MMlponrvr)
<br />04108/2015
<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 />Pro -Farm Sinclair Professional
<br />675 Cochrane Drive
<br />NAM,. T Darns Wersheger
<br />PHONa .905- 305 -1054 A /C�Ne. gOS -305 -1093
<br />Suite
<br />Manna m, East TOwer
<br />Markham, ON L3R 088
<br />.1_.. _J� -..._.
<br />EMAIL , dafnasvorshagerohubinlernallonal .coo
<br />.._
<br />INSURERS) AFFORDING COVERAGE
<br />NAICIf
<br />INSURER A: XL Insurance Amerlca, Inc.
<br />24554
<br />04130(2015
<br />IBrE
<br />Group 01 up-
<br />INSURER BALSpecialty Insurance Company
<br />37865
<br />INSURER C:
<br />X COMMERCIAL GENERAL LIABILITY
<br />18401 Von Karman Avenue, Suite 110
<br />Irvine, CA 92612
<br />INSURER D:
<br />_
<br />INSURER E:
<br />P - -4 rr
<br />$ 100,000
<br />INSURER F
<br />$ 51000
<br />COVERAGES
<br />CERTIFICATE NUMBER:71TPYPSY
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THATTHE 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 />IUTR
<br />TYPEOFINSURANCE
<br />City of Santa Ana
<br />POLICY NUMBER
<br />PMlppl
<br />MM 00Y XP
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />US000085 L 16A
<br />04130(2015
<br />.0 413 012 01
<br />EACH OCCURRENCE
<br />$ 11000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />_
<br />P - -4 rr
<br />$ 100,000
<br />MEDEXPIAn ono pemnn
<br />$ 51000
<br />CLAIMS-MADE El OCCUR
<br />oclyaGWBI
<br />X Liability
<br />PERSONAL &AW INJURY
<br />$ 11000.000
<br />GENERALAGGREGATE
<br />$ 2,000,000
<br />GEN'LAGGREGATEUMITAPPLIES
<br />PER'.
<br />PRODUCTS - COMPIOP AGG
<br />S 2000,000
<br />X POLICY
<br />PRO• LOD
<br />5
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />MAGO03760403
<br />Deductible: $2.000 Camp. 1 $2900
<br />Collision
<br />04/30/2015
<br />0413g`2016
<br />COMBINED SINGLE ILIUM=
<br />Ea..101rl
<br />2.000,000
<br />GORILY INJURY (Per Parean)
<br />$
<br />AUTO NED SCHEDULED
<br />AUTOS
<br />BODILY INJURY (Per acnlllanl)
<br />S
<br />X
<br />X
<br />HIREDAUTOS X NON-OWNED
<br />94,000 Cmnp.l AUTOS
<br />52.900 Colllslpp
<br />PRO T 1 MAr3
<br />$
<br />S
<br />UMBRELLA LIAB
<br />HOCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />S
<br />EXCESS ILIA B
<br />CLAIMS -MADE
<br />OED RETENTION$
<br />$
<br />WORKERS COMPENSATION
<br />C. AU- Ti-
<br />v
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNEREXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? F7
<br />NIA
<br />EL EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYEE
<br />S
<br />Ilye¢dasal1. NH)
<br />E. L. DISEASE - POLICY LIMIT
<br />5
<br />DESCRIPTION OF OPERATIONS W.
<br />B
<br />Professional Liability Insurance
<br />DPR 9]23490
<br />04130/2015
<br />04/30/2015
<br />Each Claim
<br />,0 0,000
<br />Annual Aggregate
<br />S 2,000.000
<br />S
<br />S
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEIIICLLS (AlLrcb ACORD 101, A4dllionel RnnmrNa SoheNUla, If mom spacq la ragoiretl)
<br />RED. 12- 27980; City of Santa Ana Regional Transportation Center (SARTC) Master Plan
<br />"City of Santa Ana, Its officers, agents, representatives, volunteers and employees" are added as additional insured to Commercial General UabilitylNon -Owned Auto but
<br />only with respect to liability arising out of the operations or the named Insured. With respect to Commercial General /Non Owned Auto, the policy(les) described above shall
<br />apply as primary for the operations of the named insul'ed an behalf of the City of Santa Ana. A cross liability clause Is
<br />Included in the policy wording. The Insurer will provide the certificate holder with thirty (30) days written notice of cancellation of the pellry.
<br />Limits shown are in US Dollars
<br />CERTIFICATE HOLDER CANCELLATION
<br />Page 1 of 1 (7 1988-20`10 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<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 />�,.•^'% ,f .,
<br />20 CIVIC Center Plaza (M -30)
<br />, Box a „ C A 92702
<br />SO
<br />SanBAne,,
<br />Page 1 of 1 (7 1988-20`10 ACORD CORPORATION. All rights reserved,
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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