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ACOR" CERTIFICATE OF LIABILITY INSURANCE
<br />`i
<br />DA04/08/2015 Y)
<br />04108/2015
<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
<br />Pro -Form Sinclair Professional
<br />675 Cochrane Drive
<br />Suite 200, East Tower
<br />Markham, ON L3R OB8
<br />CONTACT Dafna Warshager
<br />AICNNo Ext), 905-305-1054 A No :905-305-1093
<br />E-MAIL
<br />ADDRESS: dafna.warshager@hubinternational.com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSURER A:XL Insurance America, Inc. 24554
<br />US00008537LI15A
<br />INSURED
<br />N Group
<br />INSURER B:XLSpecialtyInsurance Company 37885
<br />INSURER C:
<br />18401 Von Karman Avenue, Suite 110
<br />Irvine, CA 92612
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:J2Dzw65N REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTH POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAYBE 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 INSURANCE
<br />ADDLSUBR
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYVY
<br />POLICY EXP
<br />MMIDOIYYW
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />US00008537LI15A
<br />04/30/2015
<br />04/30/2016
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY.
<br />CLAIMS -MADE 7X OCCUR
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL B ADV INJURY
<br />$ 1,000,000
<br />X Contractual Liability
<br />GENERAL AGGREGATE
<br />$ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 1,000,000
<br />X POLICY PRO LOC
<br />JECT
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />MA0003760403
<br />Deductible: $2,000 Comp. / $2,000
<br />Collision
<br />04/30/2015
<br />04/30/2016
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X2000
<br />X
<br />HIRED AUTOS AUTOS
<br />$, Comp.l X NON -OWNED
<br />$2,000 Collision
<br />PROPERTYDAMAGE
<br />Pereecident
<br />$
<br />$
<br />-
<br />UMBRELLA LAG
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />WORKERS COMPENSATION
<br />WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY YIN
<br />TORY LIMITS ft
<br />E.L. EACH ACCIDENT
<br />$
<br />ANY PROPRIETORIPARTNEWEXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />EL.DISEASE - EA EMPLOYEE
<br />$
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below,
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />B
<br />Professional Liability Insurance
<br />DER 9723489
<br />04/30/2015
<br />04/30/2016
<br />Each Claim
<br />1,000,000
<br />Annual Aggregate
<br />$ 1,000,000
<br />$
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />IBI Project 30866 Santa Ana General Plan Circulation Element Update
<br />"City of Santa Ana, its officers, employees, agents, volunteers and representatives" are added as additional insured to Commercial General Liability, Automobile Liability
<br />and/or Umbrella Liability only, but only with respect to liability arising out of the operations of the named insured.
<br />The Insurer will provide the Certificate Holder with thirty (30) days written notice of cancellation of the policy.
<br />Limits shown are in US Dollars. 41 � -2o t5-2isG
<br />CERTIFICATE HOLDER CANCELLATION I
<br />ACORD 25 (2010/05)
<br />Page 1 of 1 @ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATETHEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE W ITH THE POLICY PROVISIONS.
<br />City of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />20 CIVIC Center Place, M-20
<br />P.O. Box 1988
<br />Santa Ana, CA 92702-1988
<br />ACORD 25 (2010/05)
<br />Page 1 of 1 @ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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