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AC C? YCERTIFICATE OF LIABILITY INSURANCE
<br />219/2016�p )
<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(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 Endorsements .
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. Inc. LIC # 0726293
<br />505 N Brand Blvd, Suite 600
<br />CONTACT Mei Chan
<br />PHONE .818-539-2300 FAx WC .B18-539-2301
<br />E-MAIL Mei_Chan @ajg.com
<br />Glendale CA 91203
<br />INSURENS) AFFORDING COVERAGE NAIC#
<br />INSURER A:RIver ort Insurance Company 36684
<br />10/1/2015
<br />INSURED
<br />INSURERS,NeW York Marine And General Insuran 16608
<br />Interval House
<br />P.O. Box 3356
<br />INSURER 0
<br />Seal Beach, CA 90740
<br />JNSURER D;
<br />INSURER E ;
<br />INSURER F;
<br />COVERAGES CERTIFICATE NUMBER• 611926704 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 />ILTR NSR
<br />TYPE OF INSURANCE
<br />ADDI,
<br />INSID
<br />BUSH
<br />WVD
<br />POLICY NUMBERPOLICY
<br />EFFOrYYYY
<br />P(IMM/LDICOY EXP
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X OCCUR
<br />Y
<br />RIC00147888
<br />10/1/2015
<br />10/1/2016
<br />EACH OCCURRENCE $1000000
<br />OAMI TO RE
<br />PREMISES (Ea occEa ce $100,000
<br />MED EXP IAny one emon) $5,000
<br />X Pro(Lie6.
<br />X SDxualMlscondurt
<br />PERSONAL &ADV INJURY $1,000,000
<br />DEN ERAL AGGREGATE $3,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />POLICY JUST LOC
<br />PRODUCTS-COMP/OP AGG $3,000000
<br />S
<br />OTHER;
<br />AUTOMOBILE
<br />LIABILITY
<br />MBINNED IL $
<br />Ea acoltlsnt
<br />BODI LY INJURY (Per peraon) 3
<br />ANY AUTO
<br />AUTSS NEp AUTOSULEO
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />AUTOS
<br />BODI LY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Peracoldenl $
<br />A
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />RELOO14789
<br />1011/2015
<br />10/1/2018
<br />EACH OCCURRENCE $2,000,000
<br />X
<br />EXCESS LIAe
<br />CLAIMS -MADE
<br />AGGREGATE $2,000,000
<br />DED IX
<br />I RETENTION.O
<br />$
<br />B
<br />ANDEMRSCOMPENSAT ITV YIN
<br />ANVPROPRIETOR/PAR'INEWEXeOUTIVE171,EAOIhIACCIUENT
<br />orric8R/MEMBER EXCLUDED? N
<br />NIA
<br />WC201000006070
<br />2/112016
<br />2/1/2017
<br />X PEAR E oTH-
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />(Mandatory In NH)
<br />doiarbe under
<br />E, L. DISEASE - POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />A
<br />Crime/Employee Theft
<br />Forgery &Alteration
<br />RIC00147838
<br />RICO0147888
<br />10/112015
<br />10/1!2015
<br />1011/2016
<br />10/1/2015
<br />Deductible: $1,000 300,000
<br />PodU0II1dot$1,000 200,000
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />Carrier A: Blanket Building Coverage limit: $4,339,2001 Special Form / Deductible $1,000 / effective 10-01-2015 to 10-01-2016
<br />Carrier A: Blanket Business Contents Limit: $530,000 / Special Form / Deductible $1,000 / effective 10.01-2015 to 10-01-2016
<br />Contract # 2012-050. City of Santa Ana, Its officers, agents, employees and volunteers are named additional insured with respect to the
<br />General Liability policy of the named insured. Such Insurance Is primary and non-contributory. CG2026 Endorsement attached. Waiver of
<br />Subrogation for Workers Compensation policy applies in favor of certificate holder.- Endorsment to follow
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEREDIN
<br />20 City of Santa Ana Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Terri Eggers k rib
<br />20 Civic Center Plaza, M-25 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 USA
<br />D 19882014 ACORD CORPORATION. All rights reserved
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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