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211 OC -0000 SINSA1 <br />,a►cvRvP CERTIFICATE OF LIABILITY INSURANCE <br />�--- J <br />DATE(MMrDDNYYY1 <br />0 612 212 01 7 <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(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 statemont on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), <br />PRODUCER License # 0564249 <br />N�AIPCT <br />Heffernan Insurance Brokers <br />18004 Sky Park Circle, Suite 210 <br />Irvine, CA 92614 <br />arc°, No, Ext): 1 (949) 771-3400 mac, Nol:(949) 771-3401 <br />E-MAIL <br />DRESS: <br />INSURERS AFFORDING COVERAGE NAIC # <br />02/0112017 <br />INSURER A: Nonprofits Insurance Alliance of California 01184 <br />EACH OCCURRENCE $ 1,000,000 <br />INSURED <br />INSURER B: QBE Insurance Corporation 39217 <br />INSURERC: <br />2-1-1 Orange County <br />1505 E. 17th Street <br />Suite 108 <br />INSURER D: <br />INSURER E <br />Santa Ana, CA 92705 <br />INSURER F <br />A <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 />TR <br />TYPE OF INSURANCE <br />ADDL <br />SUBR <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPI <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCURX <br />201703104NPO <br />02/0112017 <br />02/01/2018 <br />EACH OCCURRENCE $ 1,000,000 <br />DAMAGE TISESO RENTED ence $ 500'000 <br />GEN'L <br />MED EXP (Ary oneperson) g 20'000 <br />PERSONAL & ADV INJURY $ 1,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY � ECT � LOC <br />OTHER: <br />GENERAL AGGREGATE $ 2,000,000 <br />PRODUCTS-COMPICPAGG $ 2,000'000 <br />$ <br />A <br />AUTOMOBILE <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />AOS ONLY X AUTO ONEY <br />11TCH <br />201703104NPO <br />02/01/2017 <br />02/01/2018 <br />O{ OMaBINEeD SINGLE LIMIT $ 1,000,400 <br />BODILY INJURY Per person)$ <br />INJURY Per accldenl $ <br />BODILY <br />PROaccide,, AMAGE $ <br />A <br />X <br />UMBRELLA LIAB <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />201703104UMBNPO <br />0210112017 <br />02/0112018 <br />EPAe <br />OCCURRENCE $ 2'000'000 <br />AGGREGATE $ 2,000,000 <br />DED I I RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y 1 N <br />ANY <br />FICEORIETORIIARTNEEDE7ECUTIVE ❑ <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />STATUTE ETH - <br />E. L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />E. L, DISEASE -POLICY LIMIT $ <br />B <br />A <br />Disability-AD&D-Trav <br />Professional Liabili <br />201703104ACC <br />201703104NPO <br />02/01/2017 <br />0210112017 <br />02101/2018 <br />02101/2018 <br />60,000 <br />Ea. Occurance 1,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 701 Additional Remarks Schedule, may be attached If more space Is required <br />Re: As Per Contract or Agreement On File with Insured. dity of Santa Ana, Community Development Agency is Included as an additional insured (Primary) on <br />General Liability policy per the attached endorsement, if required. <br />MWA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City ACCORDANCE WITH THE POLICY PROVISIONS. <br />Community Development Agency. <br />Administrative Services Division M-25 <br />20 Civic Center Plaza AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92701 <br />ACORD 26 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />