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CERTIFICATE OF LIABILITY
<br />5r'DATE t WDDIYYYY)
<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 />BELO'w. THIS CERTIFICATE OF INSURANCE, DOES NOT CONSTITUTE. A CONTRACT BETWEEN THE ISSUING INSURER1Sj, AUTHORIZED
<br />REPRESENTATIVE, OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate hoider is an ADDITIONAL INSURED, the policy(ies) must be 'endorsed. If SUBROGATION 15 WAIVED, SUbject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate doses not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Crystal & Company
<br />CIBC Insurance Services LLC
<br />32 Old Slip
<br />New York NY 10005
<br />INSURED_ ..
<br />Palermo TT Holdings, Inc
<br />0477 Waples, Smite 100
<br />San Diego CA 02121
<br />r..rt\It=0AnI=Q n'9=RTMtrA,Tr_ Nil lnM4MPID- I7iiAdrC i791 , 01=111cie`eai Nil vaaczcD-
<br />THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BEI HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />�a�tP" ,Jonathan Thomas
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.
<br />(A/C,NNo, Ext). 415-040 7500 iArC:. Nof 4 15-946-7550
<br />1a5 cr stalco.com
<br />ADDRESS, i olnatltan tt7OITy
<br />........INSURER{SI AFFORDING COVERAGE MAIC #
<br />LIMITS
<br />INSURER A:Indlan Harbor Insurance Company 30040
<br />TTHOLG
<br />INSURERS Valley Forge InsUrance Company 20508
<br />DAMAGE TOR NTEG.....
<br />PRPASES.Ea31,000000.....
<br />INSURER :National Fare Insurance Company of 20478
<br />MED EXP (,Arty one pereum) _ _'515,000
<br />INSURERContinental Casualty Company 20443
<br />PERSONAL M ADV INJURY .S1.000, 000
<br />..S2,000,O�00
<br />INSURER E
<br />r..rt\It=0AnI=Q n'9=RTMtrA,Tr_ Nil lnM4MPID- I7iiAdrC i791 , 01=111cie`eai Nil vaaczcD-
<br />THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BEI 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 15 SUBJECT TO ALL THE TERMS.
<br />EXCLUSIONS AND CONDITION'S OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR ADSL SUBR .... _._.. POLICY EFF POLICY EXP
<br />TYPE OF INSURANCE
<br />LTR _ _ INSD WVD POLICY NUMBER: MMIDDlYYYY MMlODfYYYY
<br />LIMITS
<br />P X COMMERCIAL GENERAL LIABILITY 6024533045 ...._ .. 5/1/2016 5/112017
<br />EACHOCCCURRENCE $1,000,000
<br />CLAIMS -MADE X OC'ICUR
<br />DAMAGE TOR NTEG.....
<br />PRPASES.Ea31,000000.....
<br />MED EXP (,Arty one pereum) _ _'515,000
<br />PERSONAL M ADV INJURY .S1.000, 000
<br />..S2,000,O�00
<br />GEr L AGGhFE'3A7E LIMIT APPLIES PER
<br />GENERAL A0,GPEGATE
<br />JECT X L 01 -
<br />PRODUCTS - COM PIOP AGG S2,000,000
<br />C AUTOMOBILE LIABILITY 5,,
<br />6024,i�3a5£h/1r2,r�16 5r1re rr1 r
<br />l'INC,LE LIMN
<br />• '1,saa,u2r1
<br />`Ea
<br />a< �iJFC,
<br />X ANY AUTO
<br />PODIL'( ILUURr (,P,?r pars+om
<br />K ULO7S1t~uELt ,x UT, ',i
<br />BODILY INAJRY (Per ac.cident) S__....
<br />NON -OWNED
<br />X HIRErtAi.ITMJS X
<br />_.... __.. _......
<br />l�AhlVr cE
<br />ptRO '
<br />cdenf
<br />p,, ,1
<br />....'C_.
<br />1
<br />X UMBRELLA LIAS X OCCUR 6024533093 5/1,20IS 5/112017
<br />EAC"1C7C'CAJRREN(,E510,000,0010
<br />EXCESS LIAR CLAIMS -MADE
<br />Af3Gk.EC,4rE *10,000.00:0
<br />DED RIETENTION,5
<br />C1 WORKERS COMPENSATION 50324533076 - 5,1//2016 5/1,12017
<br />X PER 0TH.:
<br />D AND EMPLOYERS' LIABILITY Y/N 6024533062 5/1/2016 5f 1/2017
<br />STATUTE Ef; _.
<br />AIVPRC7PRIETORY AR I NE 'R L(EC JTIVE ------'...
<br />E.I.. EACH ACCIDENT ;11,000 000
<br />()FFICER'+MEMSER-XCCLUDED'v N r A
<br />(Mandatary Ira NH)
<br />E.L. DISEASE - E4 EMPL.(DYEE 1;1 0001000
<br />If tnrler
<br />DESCRIPTiOri OF OPERATIONS below
<br />E CIS EAS E POLICY LIMI T 31,000,000
<br />A Tech Professsnnal Llah MTP003220001 51112016 511/20/7
<br />5,000000 Each Claim
<br />Retroactive Date 1/V92
<br />5.000,000 Aggregate
<br />Claims Made
<br />t00 000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS d VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana its officers, employees, agents volunteers and representatives is included as Additional Insured as required by written
<br />contract, but limited to the operations of the InSured under said contract, per the applucable endorsement with respect to the General Liability
<br />and Automobile Liability policies.
<br />4�, 4/
<br />t, CMI II -HA I t MULULK UANGELLA I IUN
<br />Cit of Santa. Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />00 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 02701-0000,
<br />AUTHORIZED REPRESENTATIVE
<br />R "
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/0.1') The ACORD name and logo are registered marks of ACORD
<br />
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