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OP ID: YC
<br />`' "wlCERTIFICATE OF LIABILITY INSURANCE
<br />OATJ
<br />A
<br />12/09/
<br />210912001516
<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 />Narver Insurance
<br />641 W. Las Tunas Drive
<br />Box 1509
<br />Gabriel, CA 91778-1609
<br />WESLEY HAMPTON HOUSE
<br />CONTACT
<br />NA June Samarin
<br />PHIS8.
<br />NC 4 x 6
<br />noRleSan ss: jsamarin Unarver.com
<br />Ro
<br />LIEGE -1
<br />INSURERS AFFORDING COVERAGE
<br />wsURERA:The Hartford
<br />NAICB
<br />29424
<br />INSURED LlebertCassidy Whitmore
<br />6033 W. Century Boulevard
<br />Los Angeles, CA 90046
<br />INSURERS: Federal Insurance
<br />20281
<br />INSURER C ; Aspen Spociolty insurancs
<br />10717
<br />INSURER D;Argo Pro
<br />GENERALAGGREGATE $ 4,000,00
<br />INSURER E:
<br />INSURER F:
<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 />/LTR 790
<br />TYPE OF INSURANCE A POLICYNUMSER MOLICI00EFF POLICYEXY LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE
<br />X
<br />728SAAK0318
<br />12114/2015
<br />12114/2016
<br />EACH OCCURRENCE $ 2,000,00
<br />DAMAO
<br />PREMISES Ea occun'ence $ 1,000,00
<br />MEO EXP (Any one arson) $ 10,00
<br />PERSONAL a ADV INJURY $ 2,000,00
<br />GENERALAGGREGATE $ 4,000,00
<br />GEN'LAGGREGATE
<br />X POLICY
<br />LIMIT APPLIES PER:
<br />PRO- LOC
<br />PRODUCTS - COMP/OP AGO $ 4,000,00
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />COMBINED SINGLE LIMIT $ 21000,00
<br />(Ea nddent)
<br />BODILY INJURY (Per person) $
<br />ALLOWNED AUT09
<br />BODILY INJURY (Per accident) $
<br />SCHEDULEDAUTOS
<br />PROPERTY DAMAGE
<br />(PERACCIOENT) $
<br />A
<br />X
<br />HIRED AUTOS
<br />725BAAK0318
<br />1211412015
<br />12/14/2016
<br />A
<br />X
<br />NON-GWNEDADTDs
<br />72SBAAK0318
<br />12/1412015
<br />12/14/2016
<br />$
<br />A
<br />B
<br />C
<br />D
<br />X'
<br />UMBRELLA LIAR
<br />EXCE89 LIAB
<br />X
<br />OCCUR
<br />CI -ALMS -MADE
<br />NIA NIA
<br />72SBAAK0318
<br />71750505
<br />LRA9AF816&XPL409238
<br />CLAIMS MADE POLICY - FPA
<br />12/1412015
<br />04/01!2015
<br />12/1012015
<br />12/14/2016
<br />04/01/2016
<br />12/10/2016
<br />EACH OCCURRENCE $ 2,0,00
<br />00AGGREGATE
<br />$ 2,000,00
<br />DEDUCTIBLE
<br />X RETENTION $ 10,000
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />FFICER/MEMBER EXCLUDED?
<br />(Mandatoryln NH)
<br />II as• sc In under
<br />DESCRdsIPTION OF OPERATIONS below
<br />Professional
<br />Liability
<br />$
<br />WC BTATU� OTH�
<br />X V IMITS ER
<br />E.L. EACH ACCIDENT $ 1,000,00
<br />E. DISEASE- EA EMPLOYEE $ 1,000,00
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,00
<br />Per Claim 5,000,00
<br />Aggregate 5,000,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (AUaoh ACORD101,Additlonal Remarks8chedule,lfmor. spade is required)
<br />Certificate Holder is named as an Additional Insured ia'ragards to attached
<br />General Liability Form SS 00 08 04 05, per written contract or agreement.
<br />CITYSAA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1988 AUTHORIZED REPRESENTATIVC
<br />Santa Ana, CA 92702
<br />04,0.
<br />©1988.2009 ACORD CORpORATInN
<br />ACERB 25 (2009/09) The ACORD name and logo are registered marks of ACORD ' ff ro� M i7_r� /� x-tM,-V f ®r rn
<br />1ItWBB Uq�l l.,
<br />t02,la�-
<br />
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