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INCUS -1 OF ID: LP <br />liw l ° CERTIFICATE OF LIABILITY INSURANCE <br /><... ---' <br />D06 /2012016 <br />osrzonol6 <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 terns 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 />902 E on & Jalckso Insurance <br />San Dimas, CA 91773 <br />NAME: <br />C Lori Patterson <br />PNCN <br />__ <br />o E, .626- 914.9944 FAX 626- 914.1040 <br />A D, Nol: <br />'MAIL Lorl@jjlnsurance.com <br />ADDRESS; <br />INSURERS AFFORDING COVERAGE <br />NAICB <br />INSURER A: Lloyds' S ndicate 2987 <br />EACH OCCURRENCE <br />INSURED In- Custody Transportation Inc <br />301 E. Arrow Hwy #110 <br />San Dimas, CA 91773 <br />INSURER B: <br />CLAIMS -MADE P�I OCCUR <br />NSURERC: <br />CJ10018416 <br />10131/2015 <br />1013112016 <br />INSURER D <br />PREMISES Me occurrence <br />NSURERE: <br />MED EXP(Anyone person ) <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: 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 INSURANCE <br />ADDLSUSR <br />imima <br />AUTHORIZED <br />POLICY NUMBER <br />POLICY EFF <br />MM /DONYYY <br />POLICY E %P <br />MMIDD/YYYY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />CLAIMS -MADE P�I OCCUR <br />X <br />CJ10018416 <br />10131/2015 <br />1013112016 <br />PREMISES Me occurrence <br />$ 100,00 <br />MED EXP(Anyone person ) <br />$ 1,00 <br />PERSONAL B ADV INJURY <br />$ 1,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ 2,000,00 <br />X POLICY ❑ PRO- <br />JECT [1 LOG <br />PRODUCTS - COMP /OP AGG <br />$ 2,000,00 <br />Pot Aggr <br />$ 2,000,00 <br />X OTHER: $5000 Ded per OGG <br />AUTOMOBILE LIABILITY <br />O IIId D SINGLE LIMIT <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />5 <br />ALLOWNED SCHEDULED <br />ON-OWNED <br />HIIREDSAUTOS AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAR <br />CLAIMS MADE <br />DEO I <br />I RETENTIONS <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIASIUTY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />ST T TE ER <br />E.L. EACH ACCIDENT <br />$ <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />E. L. DISEASE - POLICY LIMIT <br />$ <br />If Yes, describe under <br />OEa RIPTION OF OPERATIONS below <br />A <br />Professional Liab <br />CJ10018415 <br />10131/2015 <br />1013112016 <br />Prof Llab 1,000,00 <br />Deduct 5,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached It mom space Is required) <br />The City of Santa Ana, 20 Civic Center Plaza,Santa Ana, CA 92702 Its <br />officers, empployees, agents and volunteers are named as additional Insureds, <br />with re and to eneral liability of the named insured, per attached form <br />CJ112A 0109. Primary fir non - contributory wording included. 30 days notice of <br />cancellation, except 10 days notice for non - payment of premium. <br />CERTIFICATE HOLDER CANCELLATION 'Ir <br />©1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE A OVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />THE EXPTION DATE THEREOF, <br />ACCORDANCE W IT THE POLICY PROVISIONS.E WILL BE DELIVERED IN <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />AUTHORIZED <br />©1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />