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- c k& <br />A� !�'a® CERTIFICATE OF LIABILITY INSURANCE <br />51DATE(M ,ODIYYYY) <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 />cortificate holder in lieu of such endorsement(s), <br />PRODUCER <br />Alliant Insurance Services, Inc. - San Marcos <br />License #: OC36861 <br />670 Rancheros Drive, Suite 100 <br />San Marcos CA 92069 <br />NAME: T Kelsey Theakston <br />___ _ <br />PHONE 760-304-715'1 FAX 760-304-7362 <br />+C -N F�U,7----4 �nIC.Ne ._._ <br />EMAIL Kelse Theakston alliant.com <br />ss. Y @ <br />_., —, <br />_ _ INSURERS)AFFORDINGCOVERAGE <br />NAIC# <br />INSURER A; Everest National Insurance Company_i__ <br />10120 <br />EACH OCCURRENCE <br />INSURED HADRINC-01 <br />INSURER 9: <br />_ <br />HadroneX, Inc. <br />2067 Wineridge Place Ste E@suRr.Rc: <br />Escondido CA 92029 <br />$10,000 <br />GEN'L <br />X <br />INSURER D: <br />PERSONAL &ADV INJURY <br />INSURER E <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JECT LOC <br />OTHER: <br />GFNERALAGGREGATE <br />INSURER F: <br />PRODUCTS-COMP/OP AGO <br />$2,000,000 <br />COVERAGES CERTIFICATE NUMBER. 2062371711 RFVISION NHMRFR- <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 />WER <br />TYPE OF INSURANCE <br />g� <br />SUBR <br />WVD <br />POLICY NUMBER <br />MMIODNYVY <br />MM/tlOMXYY <br />.� LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE FOOCCUR <br />Y <br />CFIGLOOI 10-161 <br />2/2/2016 <br />2/2/2017 <br />EACH OCCURRENCE <br />$1,000,000 <br />_DTMAGF TO RENTED '^" <br />PREMISES(Ea owurrence <br />$100,000 _ <br />MED EXP (Any one person) <br />$10,000 <br />GEN'L <br />X <br />_ <br />PERSONAL &ADV INJURY <br />$1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY ❑ JECT LOC <br />OTHER: <br />GFNERALAGGREGATE <br />_ <br />$2,000,000_ <br />PRODUCTS-COMP/OP AGO <br />$2,000,000 <br />— <br />S —.N. <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />AINI�Y AVVUyyTO <br />AUfOOSNED SUTHOEDULEO <br />AANON-OWNED <br />FARED AUTOe AUTOS <br />CFl CA00030-161 <br />5/1/2016 <br />2/212017 <br />E LIMIT Ea accitlent)___. _ <br />$1,000,000 <br />BODILV INJURY iPer person) <br />$ <br />eODILY INJURV IPer accitlon0 <br />$ <br />PROPERTY DAMAGE <br />,LPer accidont _ <br />-_.._.__.....—. <br />$ <br />$ <br />UMBRELLA LIAS <br />EXCESS LIAB <br />OCCUR <br />CLAIMS -MADE <br />EACHOCCURRENCE <br />3 <br />AGGREGATE <br />$ <br />DEO I <br />I RETENI ION$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y/N <br />ANY PROPRIETOMPARTNER/EXECUTIVE ❑ <br />OFFICERIMEMBER EXCLUDED? <br />(mandatory lnNH) <br />II Yas, descdbe under <br />DESCRIPTION OF OPERATIONS belay <br />NIA <br />PER OTH <br />STATUTE <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE EA EMPLOYE <br />__-- <br />$v <br />"—'---'—' <br />E.L. DISEASE � POLICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS LOCATIONS IVEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) <br />Certificate holder is named as additional insured as respects to General Liability when required by written contract or agreement, for services <br />provided by the named insured for the certificate holder per the attached endorsement. <br />City of Santa Ana <br />20 Civic Center Plaza, M-21 <br />Santa Ana CA 92701 <br />SHOULD ANY OPTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS <br />cREEPRESE//N//TATIVE <br />/ (AG <br />Ar npn rnrNPI PATIr1M All dr.hfe roe.—r! <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />