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rollcyiNumoer: vaur.memw 6 0 2016 <br />CERTIFICATE OF LIABILITY INSURANCE DATE(M MIDDol <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 CONTACT <br />DbM INSURANCE SERVICES NAME __.__�.....,.,____w,_..._.. .__._... �.____ <br />DEBEIHE3 INSURANCE SERVICES PHONB .(805)499-4170 ..—_LFA+" NdX (000)770-3060 <br />9 MAIL don@dmdins. com - _.__._.__. - <br />3541 OLD CONEJO ROAD #103 _Ao_ones <br />NEWBURY PARR CA 91320 _ ,... ... ,„„,._.IN S URERi6i AFf OROING COVERAGE__, _^ _NAIC# _ <br />INS°RERA:ALLIED INSURANCE COMPANY <br />INSURED T. D. SPORTS INSURERS T <br />CYPRESS INSURANCE COMPANY <br />DBA SPORT COURT OF SOUTHERN CALIFORNIA INSURER 0; IRONSHORE SPECIALTY INSURANCE CONTAIN <br />WINS..,..�" <br />21 WEST EASY STREET UNIT 107 INSURER 0: National UNION FIRE INS CO OF PITTSBURGH <br />SIMI VALLEY, CA 93065 <br />INSURER E. <br />._ _.._..... .._.____.__—. ..._...._... _...W.. <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS 15 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 />INSRr . — _ _...,. _ A6SWISS, P�CY E�fP T pOL1CV E%P .._.. __. <br />TYPE OF INSURANCE INaDI Won POLICY NU MB ER MMIDOIYYYY i1 MMIOPIYYYY LIMITS <br />Lr I , COMMERCIAL GENERAL LIABILITY iEACH OCCURRENCE S1.:..0�.Q1000 _ <br />—v <br />CLAIMS-MADC f OCCUR XE 6/1/2016 1 DAMAGE P3 i�ENiE <br />sh/ao1T ER M EAPJc,EtGv r RAN_ t. 0 4__ <br />AGS0097900 �---..�R-r- R <br />DEDUCTIBLE, $5aQQQ_R : IEXP(A, vn n) ?9 ,5j QP4.... .__.. <br />(,y JPD p�,R OG(;S2gENCE E ! PERSONAL&ADV INJURY jis1 QQQ,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: % G6NbRA1 AGGRF6ATF 19� QQQ�QQQ <br />POLICY[ JECT PRODUCTS-COMPIOPAOG IL 2 000,,000 <br />JECT LOCI _ _ <br />OTHER S <br />OUTOMOBILELiABILITY GOMDMEn SINGLE LIMITILLa accdantl ANYAOTO _ ACP 3007010519 E6/1/2016 i6J1J2014 BODILY INJURY(Pa P Ien) S <br />ALL OWNEC -i SCI1EOULEO i BODILY INJURY(Peraoodon!)AUTOSAUTOSNON-OWNED [ L -PROPERTY DAMAGEHIRED AUTOS Imo$gDTpS E etll. AU t <br />UMBRELLA LIAB R x € EAGHOCCU_RRENGE $ <br />S <br />D occuR ,.__4n.4QQ,.QQ4AiiA..�_ <br />EXCESS LIAB CLAIMS-MAOE' EBU080693832 i6/1/2016 6/1/2014 ,AGGREGATE <br />ICED RETENTIONS <br />WORKERS COMPENSATION I PSTE ATUTE YOTHR I <br />AND EMPLOYERS' LIABILITY YIN t— — <br />ANYPROPRIETORIPARTNERlEXECUTIVE LEL EACH ACCIDENT 1I, �, ORQ,QQQ <br />$ OrFICERIMEMBER EXCLUDED? NIA TDWC706422 (6/1/2016 6/1/2014 --- <br />IMendatnrylnNH) I EL DISFASE-EA-MPLOYLE- e.-OSLU rOSi..O <br />li yes, desodbe under , E L DISEASE <br />DESCRIP'f ION OF OPERATIONS below POLICYLIMT .$ �. <br />I I I I <br />I <br />i <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES iAGORD 101, Additional Remarks Sdhadule, may be attached if more apace Is requiredl <br />CERTIFICATE HOLDER AND BELOW NAMED AS AN ADDITIONAL INSUREDS TO THE ABOVE INSUREA'..FirA'f@S18C �S: <br />CANCELLATION NOTICE OF 30 DAYS (10 DAY CANCEL NON—PAY) <br />RE: CITY OF SANTA ANA a� <br />�v <br />CERTIFICATE HOLDER CANCELLATION ' <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />DAN DEBEIKCS <br />©1988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />ProduvwduNt, Fotms Boas Plus sofNYere www For aBoss combdrbT, ivePubL 0in0000-200-1977 <br />