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A� R& CERTIFICATE OF LIABILITY INSURANCE
<br />GATE05/02016
<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 LIC #OE77964 1-925-671-5110
<br />Integro Insurance Brokers
<br />2300 Contra Costa Blvd
<br />-p72
<br />CONTACT
<br />NAME: Eileen Hollander
<br />925-852-0445 Fax o: 925 0495
<br />SExt:
<br />A Eileen.Hollander®integrogroup.com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />Suite 375 N -2p16
<br />INSURERA: SENTINEL INS CO LTD 11000
<br />Pleasant Hill, CA 94523
<br />INSURED
<br />INSURER B; HARTFORD ACCIDENT & IND CO 22357
<br />Koff & Associates, Inc.
<br />INSURERC: HARTFORD INS CO OF THE MIDWEST 37478
<br />IINSURER D: HOUSTON CAS CO 42374
<br />2835 7th Street
<br />NSURER E
<br />INSURER F:
<br />Berkeley, CA 94710
<br />COVERAGES CERTIFICATE NUMBER: 46534187 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.
<br />INSR
<br />LTR
<br />TYPE OF
<br />ADDLSUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNM
<br />POLICY EXP
<br />MIDDIYYI'Y
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MAGE OCCUR
<br />X
<br />X
<br />57 SHA AZ7015 SC
<br />10/01/15
<br />10/01/16
<br />EACH OCCURRENCE $ 2,000,000
<br />DAMA ETORENTEO 1,000,000
<br />PREMISES Ee occurrence $
<br />MED EXP(Anyone person) $ 10,000
<br />PERSONAL&ADV INJURY $ 2,000,000
<br />GENLAGGREGATE LIMITAPPLIES PER:
<br />2 POLICY E PRO.
<br />JEOT LOC
<br />GENERALAGGREGATE $ 4,000,000
<br />PRODUCTS - COMPIOP AGG $ 4,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE LIABILITY
<br />X
<br />X
<br />57 UEC IZ7944
<br />10/01/15
<br />10/01/16
<br />COMBINED SINGLE LIMIT $ 11000,000
<br />Ea accident
<br />XANYAUTO
<br />BODILY INJ URY(Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />INJURY
<br />( BODILY INJUPereccldenl) $
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />H
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />A
<br />X UMBRELLA LIAB
<br />X
<br />OCCUR
<br />57 SBA AZ7015
<br />10/01/15
<br />10/01/16
<br />EACH OCCURRENCE $ 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $ 1,000,000
<br />DED 'Y I RETENTION$ 10,000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />57 NEC LY6165
<br />10 O1
<br />/ /15
<br />10/O1/16
<br />X PER OTH-
<br />STATUTE ER
<br />El, EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory In NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />D
<br />Professional Liability
<br />H-716-107422
<br />03/01/16
<br />03/01/17
<br />Each Claim 1,000,000
<br />CLAIMS -MADE
<br />In the Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACO RD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />Additional Insured(s): City of Santa Ana, its officers, employees, agents, volunteers and representatives.
<br />Applicable FOrm(e): SS0008 0405, SS1223 0611, HA9916 0312 & IH0313 0611; Claims Made Date: 04/16/14
<br />of Santa Ana
<br />20 Civic Center Plaza (M-30)
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />APPROVED AS TO
<br />Lau ra A. Rossin
<br />Senior Assistant City A
<br />USA
<br />SHOUED 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 />REPRESENTATIVE
<br />© 1988.2014 ACORD
<br />ACURD z5 (YU94/U1) The AOORD name and logo are registered marks of ACORD
<br />erunyArgo
<br />46534187
<br />�wll
<br />reserved.
<br />
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