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ACC)R ?' CERTIFICATE OF LIABILITY INSURANCE 91/2017 <br />DATE(MMroerYYYYI <br />4/14/2016 <br />THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND GONFERS 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($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, <br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polioyQes) must he endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certaln policies may require an endorsement, A statement on this certificate does not confer rights to the <br />certificate holder In (leu of such endoreem antis). <br />PRODUCER Lockton Companies <br />Three 01%Place Drive, Suite 900 <br />SL Louis M0 63141-7081 <br />(314) 4320500 <br />N N1E. <br />e, Bid): me No): <br />dvbA iEss: <br />INSUR S AFFORDING COVERAGE <br />_NAC <br />INSURER A: XL insurance America Inc. 24554 <br />INSURED T-Molode USI Inc. <br />1358772 Its Subsidiaries andAffiliates <br />1BE 38th Street <br />Bellevue WA98006 <br />INSURER B: Greenwich Insurance Company 22322 <br />INSURER c: National Union Fire Ins Co Pitts. PA 194.45 <br />INSURER D: <br />JNSURERE <br />INSURER F, <br />COVF.RAGFR I MOHI CPRTIFICATFNIIMRFp• 1d11111910 onne,AN wlaacec. vvvvvvv <br />THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A13OVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 />AND CONDITIONS OF SUCH LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />IggEXCLUSIONS <br />LTR <br />TYPE OF INSURANCE <br />pPOLIICCIES. <br />AIQeli <br />WVBIR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EX <br />I LIMITS <br />B <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X� OCCUR <br />Y <br />Y <br />RGD5000259.05 <br />5/1/2016 <br />5/1/2017 <br />EACH OCCURRENCE 1000000 <br />D I CE REN.rrenoe 1 OOO OOO <br />NEC EXP (Any oneperson) s $ 000 <br />PERSONAL &ADV INJURY S 1,000,000 <br />GENT AGGREGATE LIMIT APPLIES PER: <br />POLICY JECT LOC <br />GENERAL AGGREGATE $ 2,000 000 <br />PRODUCTS -COMPIOPAGG $ 2,000.000 <br />$ <br />OTHER <br />B <br />AUTOMOBILE <br />I <br />LIABILITY <br />ANY AUTO <br />ALLOlNNEO �SEIHyOFSULED <br />Y <br />Y <br />RAD5000257-05 <br />5/1/2016 <br />5/1/2017 <br />G BINEO SINGLE LIMIT <br />BODILY INJURY (Per Person) It XXXXOQ <br />XXXXXXX <br />BODILY INJURY (Perawdent $ XXXXXXX <br />HIURTEOD9AUTOS ABTTpyNINEO <br />Pe'accROenl AMAGE $ iZX.Xiii X <br />$ XxXXXXX <br />C <br />C <br />C <br />X <br />UMBRELLA LINE X <br />EXCESS LIAB <br />GCOUP <br />CLAIMS -MADE <br />Y <br />N <br />19086894 <br />SIR applies per policy <br />terms Kee conditions <br />5/1/2016 <br />5/1/2017 <br />EACH OCCURRENCE $ 5,000,000 <br />AGGREGATE $ $ QQQQ <br />00 <br />PEO X RETENTION$2500D <br />$ xixxxXX <br />AWORKERS <br />A <br />COMPENSATION <br />ANDOMPLOYERS'LIABILITY <br />ANY PRCPRIETOWPARI NERIEXECLITIVE YIN <br />OFFIOENU51NMI <br />dWa.d.t.1 he OFFICEaIMEMBEA E%CWDfiD? <br />DEBCRIPTIONOr OPEI'NTIONebd. <br />NIA <br />N <br />RWD5000301-04 AOS <br />RWR5000302-04 Wl <br />5/1/2016 <br />$/l/2016 <br />5/1/2017 <br />51/2017 <br />PER OTH- <br />X srnmrE <br />E.L EgCH ACCIDENT $ <br />EL, DISEASE EA EMPLOYEE 1 OQQ QQO <br />EL.O SEABE PDLIGY LIMIT 1 O00000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES ARaoll ACORD 101, Additional Remarks Sohetlule, May be selection If more space le mP uhed A,..t 41\I <br />The Cedificate Holder Mtd other endues debuted by written contract, etaluta, ormit nppbcntion or wriHen nb'Iccmmd ora addiNunel insureds�a, �,,pr�" ,"eN"rdleibt ch(idibutory <br />basis undef $onaral Lability and ere additional insl¢ed under auromobilo Uabi Ity m required by w,bre, eoullna. Wolver oFSubroyedon nppp��b gtxl at liability and <br />automobile Nubility as required by written conhect. "*Sea Adncded Endorsements"* R6: SPECIAL EVENT � CITY OF SANTA ANA 1 DE MAYO EV .NT APRIL 30, <br />2016 THROUGH NTAY 1, 2016, <br />,s+e'vsu�' <br />A gilvia cip,drnirt. <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL OB DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS, <br />14001710 <br />CITY OF SANTA ANA <br />PARKS & RECREATION COMMUNITY SERVICES AGENCY <br />ATTN: CLERK OF THE CITY COUNCIL <br />PO BOX 1988 <br />SANTA APIA CA 92702-1988 <br />rho ACORD name and logo are registered marks of ACORD <br />s <br />All riuhts <br />