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AC" IDIPP CERTIFICATE OF LIABILITY INSURANCE
<br />IMMI D/YYYY)
<br />F
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />8OATE
<br />016
<br />THISCERTIFICATECERTIFICATE 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 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 />NONTACT
<br />AME: Allison Andrus License #0K93926
<br />Hall & Company
<br />A/E Insurance Services
<br />PHONE FAX
<br />(ALC,_No,.-Ext) 360-626 2007 (A/c 360-598-3703
<br />E-MAIL aandruS ndcom an
<br />halla
<br />.D_REs s @ p yCom
<br />APORES
<br />19660 10th Ave NE
<br />INSURERS) AFFORDING COVERAGE NAIC #
<br />Poulsbo WA 98370
<br />INSURER A:Zurich American Insurance Company_ 16535
<br />EACH OCCURRENCE
<br />bAfv1AGE"PQRE1�1'I"15
<br />P,REMISES_(Ea,occurranae�
<br />INSURED 25
<br />INSURERB:Steadfast Insurance Company 26387
<br />Dudek
<br />INSURER C
<br />605 3rd Street
<br />-
<br />Encinitas CA92024
<br />INSURERD:
<br />INSURER E:
<br />INSURER F:
<br />$10,000
<br />COVERAGES CERTIFICATE NUMBER: 2128240127 RFVISInN MI IMRFR-
<br />._-----------------
<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 />ILTR
<br />TYPE OF INSURANCE
<br />INSD
<br />WVD
<br />POLICY NUMBER
<br />MM/DDNYYY
<br />MM/DDNYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADEOCCUR X I
<br />�J
<br />GLOO14631100
<br />8/28/2016
<br />8/28/2017
<br />EACH OCCURRENCE
<br />bAfv1AGE"PQRE1�1'I"15
<br />P,REMISES_(Ea,occurranae�
<br />$1,000,000
<br />$100,,,,000
<br />X
<br />OCP/XCU/BFPD
<br />MED EXP (Any one person)
<br />$10,000
<br />X __
<br />Cross Liability_..____
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L
<br />_.
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY X...I PE LOC
<br />_
<br />PRODUCTS - COMP/OP AGG
<br />------...---
<br />—
<br />$2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP014632900
<br />8/28/2016
<br />8/28/2017
<br />O N-1715
<br />ac
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />AUTOS OWNED SCHEDULED
<br />....------- --- „_----.._.._....-----._..._.....-----
<br />BODILY INJURY (Per accident)
<br />.............
<br />$
<br />X
<br />HIRED AUTOS X NON - ED AUTOS
<br />Per acoident)
<br />$
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />AUC014640700
<br />8/28/2016
<br />8/28/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />AGGREGATE
<br />$1,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION $0
<br />$
<br />A
<br />WORKERS COMPENSATIONWC014633000
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L,
<br />OFFICER/MEMBER EXCLUDED?
<br />N / A
<br />8/28/2016
<br />8/28/2017
<br />X STATUTE OERH
<br />EACH ACCIDENT
<br />--
<br />..__
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />B
<br />Professional Liab Claims Made
<br />PECO14631400
<br />8/28/2016
<br />8/28/2017
<br />$1,000,000 Per Claim
<br />Contractors Pollution Liab: Occur
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />The City of Santa Ana its officers, employees, agents, volunteers, and representatives are an Additional
<br />Insured on the Commercial General Liability and Auto Liability when required by written contract or
<br />agreement regarding activities by or on behalf of the Named Insured. The Commercial General Liability
<br />insurance is primary insurance and any other insurance maintained by the Additional Insured shall be
<br />excess only and non-contributing with this insurance. A waiver of subrogation applies to the Commercial
<br />General Liability, Auto Liability, Umbrella / Excess Liability and Workers rompensation / Employers
<br />Liability in favor of the Additional Insured. REVIEWED BY: EUNICE HEREDIA(PG 1OF )�
<br />CERTIFICATE HOLDER CANCELLATION tz V
<br />O 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />PO Box 1988
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE
<br />O 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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