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AC"Ro° CERTIFICATE OF LIABILITY INSURANCE <br />�� 3/1/2017 <br />DaTE 9/7/20D <br />9/7/2016 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />TYPE OF INSURANCE <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />SUER <br />WD <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />POLICY EFF <br />MMIDDIYYYY <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(tes) must have ADDITIONAL INSURED provisions or be endorsed. <br />LIMITS <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />GENERAL LIABILITY <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />N <br />PRODUCER LOCKTON COMPANIES <br />NAMEA T <br />3/1/2017 <br />2100 ROSS AVENUE, SUITE 1400 <br />DALLAS TX 75201 <br />214-969-6700 <br />cONE <br />Na Ext: a No: <br />CLAIMS-MADE�OCCUR <br />EMAIL <br />ADDRESS: <br />Santa Ana CA 92701 <br />INSURIERIS1 AFFORDING COVERAGE <br />NACa <br />ACORD 25 (2016/03) <br />INSURER A: Hartford Under Writers Insurance Company <br />30104 <br />tCOMMERCIAL <br />INSURED Alliance Data Systems Corp. <br />INSURER B: Hartford Fire Insurance Company <br />19682 <br />1368343 and its Subsidiaries & Affiliates <br />Epsilon Data Management, LLC <br />7500 Dallas Parkway, Suite 700 <br />INSURER C: Twin City Fire Insurance Company <br />29459 <br />INSURER D: Midwest Employers Casualty Company <br />23612 <br />E E <br />Plano TX 75024 <br />INSURER 1: <br />COVERAGES CERTIFICATE NUMBER: 142.31997 REVISION NUMBER: XXXXXXX <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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />AODL <br />INSD <br />SUER <br />WD <br />POLICY NUMBER <br />POLICY EFF <br />MMIDDIYYYY <br />POLICY EXP <br />MMIDDf/YYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />Y <br />N <br />46 THEN ZR 8780 <br />3/1/2016 <br />3/1/2017 <br />EACH OCTCTURRENCE 1000 000 <br />20 Civic Center Plaza - M-23 <br />CLAIMS-MADE�OCCUR <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) <br />PREMISESOEe occurrence 1000,000 <br />©1988-2015 ACORD CORPORATION. All rights reserved <br />tCOMMERCIAL <br />MED EXP (Any one erson 10,000 <br />PERSONAL &ADV INJURY $ 1,000,000 <br />GEHL AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE Is 3,000000 <br />POLICY JECT [:] LOC <br />PRODUCTS - COMPIOPAGG $ 3,000,000 <br />Is <br />OTHER: <br />B <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />(( <br />46 <br />L7 <br />COMBINED SINGLE LIMIT <br />Ea accident $ 1,000,000 <br />E <br />X <br />ANYAUTO <br />UEN ZR 8786 (MA)1 <br />3%1016 <br />3%L/20 <br />BODILY INJURY (Pon parson) $ XXXXXXX <br />AUTOS ONLY AUTOSULED <br />BODILY INJURY(Peraccident $ XXXXXXX <br />PROPERTY DAMAGE $ XXXXXXX <br />Per acadeM <br />HIRED NON -OWNED <br />A TOS ONLY AUTOS ONLY <br />$XXXXXXX <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE $ XXXXXXX <br />EXCESS LIAB <br />CLAIMS -MADE <br />NOT APPLICABLE <br />AGGREGATE Is XXXXXXX <br />DEC I I RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />N <br />46WBA06224 <br />7/1/2016 <br />7/1/2017 <br />PER OTH- <br />X STATUTE ER <br />YIN <br />ECUTIVE � <br />NIA <br />EL EACH ACCIDENT $ 1,000,000 <br />OANY <br />FFICPROPP ERIMEMEER E%CWDEDi <br />(Mantlataryln NH) <br />E. L. DISEASEEAEMPLOYEE 1,000,000 <br />If 's deddribe under <br />DESCRIPTION OF OPERATIONS below <br />EL DISEASE -POLICY LIMIT is 1,000,000 <br />D <br />Old, Excess WC&EL- <br />N <br />N <br />EWC006816 <br />7/1/2015 <br />7/1/2017 <br />EL LIAB LIMIT.$1,000,000 <br />$500,000 Retention <br />EL RETENTION: $500,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS HOLDER, APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TERM(S) REFERENCED. <br />RE: Collision/Comprehensive insurance provided for Owned "Antos" only and Hired "Autos" only. Deductibles: Collision - $500 / Comprehensive - $500. Re: <br />Event: Nestle event. Dates: September 10 - September 11, 2016. Certificate Holder includes: City of Santa Ana, its officers, employees, agents, and <br />representatives. <br />CERNFIOAIE HOLDER <br />--fV <br />-'ELLAIION See Attachment <br />CA V <br />�THE EXPIRATION DATE LD ANY OF THE ABOVE DESCRIBEDD BEFORE <br />NIOTICCE WILL EBE DELIVEREDS BE EIN <br />J�� <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Y <br />AUTHORIZED REPRESENTATIVE <br />14231987 <br />City of Santa Ana <br />Attn: PRCSA <br />20 Civic Center Plaza - M-23 <br />Santa Ana CA 92701 <br />ACORD 25 (2016/03) <br />©1988-2015 ACORD CORPORATION. All rights reserved <br />The ACORD name and logo are registered marks of ACORD <br />