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Jam— N ® <br />°� ° CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DDIVYYY) <br />DBI2BI2D,8 <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(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). <br />PRODUCER <br />Aon Risk Services Northeast, Inc. <br />Boston MA Office <br />CONTACT <br />NAME <br />(aCNNo.EXtX (866) 283 -7122 P� No.): (800) 363 -0105 <br />One Federal Street <br />Boston MA 02110 USA <br />EMAIL <br />ADDRESS: <br />INSURERS) AFFORDING COVERAGE <br />NAIC k <br />INSURED <br />INSURER A: Zurich Insurance PIC <br />AA1780059 <br />CODIOgiC Inc <br />1000 Alderman Drive <br />Alpharetta GA 30005 USA <br />INSURER B: American Guarantee & Liability Ins Co <br />26247 <br />INSURER C: ACE American Insurance Company <br />22667 <br />INSURER D: Lloyd's Syndicate NO. 2987 <br />AA1128987 <br />INSURER E: Lloyd's Syndicate No. 2623 <br />AA1128623 <br />$1,000,000 <br />INSURER P: <br />MED EXP(Anyone person) <br />COVERAGES CERTIFICATE NUMBER: 570061553961 REVISION NUMBER: <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. Limits shown are as requested <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />MMIODIYYVY <br />MIL111 bX1 <br />MIDDe`YYYI <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />OGLG <br />EACH OCCURRENCE <br />$1,000,000 <br />CLAIMS -MADE X❑OCCUR <br />PREMISES Ea occurrence <br />$1,000,000 <br />MED EXP(Anyone person) <br />$5,000 <br />PERSONAL &ADV INJURY <br />$2,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$2,000,000 <br />X POLICY ❑ PRO ❑ LOG <br />JECT <br />PRODUCTS - COMPIOP AGO <br />$2,000,000 <br />OTHER: <br />B <br />AUTOMOBILE LIABILITY <br />BAP 8376848 -17 <br />01/01/201601/01 <br />/2017 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$1,000,000 <br />BODILY INJURY( Per person) <br />X ANY AUTO <br />BODILY INJURY (Par aradenq <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIRED AUTOS NON -OWNED <br />PROPERTY DAMAGE <br />ONLY AUTOS ONLY <br />Per accident <br />Comprehensive Deduct <br />$1,000 <br />A <br />IAB <br />UMBRELLA ILIAD <br />% <br />OCCUR <br />W51600029 <br />12/31/2015 <br />12/32016 <br />EACH OCCURRENCE <br />1,000,0 00 <br />X <br />EXCESS LIAB <br />CLAIM &MADE <br />AGGREGATE <br />$1,000,000 <br />DED <br />RETENTION <br />B <br />WORKERS COMPENSATION AND <br />837684517 <br />IPER OTH- <br />X STATUTE ER <br />EMPLOYERS'LIABILRY YIN <br />Workers compensation (ADS <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />B <br />ANY PROPRIETORI PARTNER I EXECUTIVE <br />NIA <br />203805718 <br />Ol/Ol/201601/01/2017 <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />Workers Compensation (OH) <br />E.L. DISEASE -EA EMPLOYEE <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 />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, nay be allached If more space Is required) <br />City of Santa Ana, its elected officials, employees and agents are included as Additional Insured in accordance with the policy <br />provisions of the General Liability policy. <br />OJ.eY�S - dry Nsd <br />CERTIFICATE HOLDER <br />CANCELLATION <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />v <br />c <br />v <br />a <br />v <br />O <br />S <br />io <br />V) <br />ca <br />0 <br />0 <br />h <br />O <br />Z <br />N <br />N <br />40-- <br />C <br />L) <br />�J <br />"ter# <br />R3 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS, <br />City Of Santa Ana <br />AUTHORIZED REPRESENTATIVE <br />20 civic Center Plaza <br />Santa Ana CA 92701 USA <br />�,�//// <br />c�4an i'/fr� c7eGaveed c/Y /LL`> �saa <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />v <br />c <br />v <br />a <br />v <br />O <br />S <br />io <br />V) <br />ca <br />0 <br />0 <br />h <br />O <br />Z <br />N <br />N <br />40-- <br />C <br />L) <br />�J <br />"ter# <br />R3 <br />