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<br />`�'�I� b CERTIFICATE OF LIABILITY INSURANCE
<br />♦,,,,,,,,,,, , ,"
<br />DATE (MMIDDIYYYY)
<br />06'1312016
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder In lieu of such endorsoment(s).
<br />PRODUCER
<br />A7_Ct11, Insurance Seev Agy Inc
<br />7659 E Panvilse Lane LOT 4
<br />Scottadalo AZ 35260
<br />NAME: Marl Capron.
<br />Af4NO, Ext: 4809488008 Atc, Noi: 456.943.5192
<br />ADDRESS: Cadc�baZt101u19W'aucVFDIYI
<br />.W,._,.. INSURER($) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: NETHRRf -ANDS INS CO
<br />24171
<br />INSURED
<br />Legacy Vn9oe Muni Ire
<br />477 Devii❑ Rd Ste 103
<br />Napa CA 945$3
<br />INSURER 3; GOLDEN EAGLE INS CORP
<br />INSURER C
<br />MED EXP (Any one Parson) $ 5000
<br />INSURER D
<br />INSURER E:
<br />GENU AGGREGATE LIMIT APPLIES PER
<br />i( POLICY F—]jECT EILOC
<br />OTHER'.
<br />INSURER F;
<br />PRODUCTE - COMP /OP AGG $ 2000000
<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 />CE U IFICATE 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 />LTR
<br />TYPE OF INSURANCE INSD
<br />WVD
<br />POLICY NUMBER
<br />POLICY t�l` POLICY LAF
<br />(MMlOD7YYYY) (MMYDDfYVYY)
<br />r LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE ®OCCUR
<br />SANTA .ANNA, CA 92701
<br />CIE P1090897
<br />05/01/2016 0510[12011
<br />aR
<br />nSwlYi
<br />EACH OCCURRENCE 3 1000000
<br />_ !00000
<br />PREMISES (EA occmonne) $
<br />MED EXP (Any one Parson) $ 5000
<br />PERSONAL & ADV INJURY $ 1000000
<br />GENU AGGREGATE LIMIT APPLIES PER
<br />i( POLICY F—]jECT EILOC
<br />OTHER'.
<br />GENERAL AGGREGATE $ 200NOD
<br />PRODUCTE - COMP /OP AGG $ 2000000
<br />g
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY _ AUTOS
<br />HIRED - NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />9�
<br />r�^^pp'�( "�'"�.rXys
<br />yyYY ytA ,+
<br />LLF Get.+
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<br />�,,s^
<br />"�„w^^-'
<br />{i Q,`�
<br />Ea 00116,M) IT S
<br />BODILY INJURY(Pornemon) $
<br />HOD ILY I NJURY(Pw acddontj $
<br />..
<br />(Paraccide,N $
<br />UMBRELLA LIA9
<br />EXCESS LIAR
<br />OCCUR
<br />CLAIMS -MADE
<br />1
<br />EACH OCCURRENCE $
<br />ry
<br />AGGREGATE $
<br />DED RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />Nn EMPLOYEk3' LIABILITY
<br />NY PROPRIETORIP.4RTNERIEYECUTIVE YIN
<br />FFIeE}RNEMBER EXCLUDED' NIA
<br />(Mandatory M AN)
<br />DfSCRIFTION OF O PERATION36dm
<br />_
<br />WC1090998
<br />07110/2016 07/1012017
<br />%t STATVTE ER
<br />ELL, EACHACCIDENT $ 1000000
<br />E.L. DISEASE -EA EMP40YEE S 10100000
<br />E . DISEASE, POLICY LIMi7 $ 1064000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORO 101, Additional Remarks Schedule, {Pay be attached If more space Is owibbed)
<br />tem L 477 Deviin Rd, Ste 103,Napa,CA,94558,
<br />CERTIFICATE HOLDER CANCELLATION
<br />1888 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2616103) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />`rUR CITY OF SANTA ANNA
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CI' -NTHR PLAZQ
<br />AUTHORIZED REPRESENTATIVE
<br />SANTA .ANNA, CA 92701
<br />CY.S�t"Fv.Gq:(H'ttw
<br />1888 -2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2616103) The ACORD name and logo are registered marks of ACORD
<br />
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