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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIPDIYYY)
<br />2/9/2016
<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 pollcy(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 ondorsement s .
<br />PRODUCER
<br />Arthur J. Gallagher � Co.
<br />Insurance Brokers of CA. Inc. LIC # 0726293
<br />N Brand Blvd, Suite 600
<br />CONTNACT
<br />Mei Chan
<br />PnoNE 818-539-2300 PAX .818-539-2301
<br />. Mei_Chan@ajg.com
<br />M.�.4MANG,e�t-'-Chan@ajg.com
<br />Glendale CA 91203
<br />INSI AFFORDING COVERAGE
<br />NAIL#
<br />INSURER A:RIvEl Insurance Company
<br />36664
<br />RIC00147$58
<br />INSURED
<br />INSURER SINEW York Marine And General lnsuran
<br />16608
<br />Interval House
<br />P.D. Bax 3356—
<br />INSURER 0:
<br />INSURER D:
<br />Seal Beach, CA 90740
<br />INSURER E
<br />INSURER F
<br />PERSONAL&ADV INJURY $1,000000
<br />COVERAGES CFRTIRICATF NIIvI 611928704 ooemm�n, ru loco ce.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLIRED 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 />L7R/NSD
<br />TYPE OF INSURANCE
<br />MD
<br />POLICYNUMBER
<br />POLICY EFF
<br />IDDIYYYY
<br />POLICY EXP
<br />MIDDflVYYI
<br />UMTTS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIM9MADEWRT❑X OCCUR
<br />Y
<br />RIC00147$58
<br />10/112015
<br />10/1/2016
<br />EACH OCCURRENCE $1000000
<br />E TED
<br />PREM E occurrence)$100,000
<br />MED EXP (Anyone Perron) $5,000
<br />X Prof Llab
<br />X SDXUalMlsconduct
<br />PERSONAL&ADV INJURY $1,000000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JKC7 [7 LOC
<br />GENERAL AGGREGATE $3,000000
<br />PRODUCTS-COMP/OPAGG $3000,000
<br />$
<br />OTHER ;
<br />AUTOMOBILE
<br />LIABILITY
<br />BIN $
<br />Ea eccldenl
<br />ANYAUTO
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHC-0ULEO
<br />AUTOS AUTOS
<br />HIRRD AllT05 AUUTOSWNED
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE $
<br />Peracoldent
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />RELOO14789
<br />1011/2016
<br />1011/2016
<br />EACH OCCURRENCE $2,000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATE $2,000,000
<br />DED X
<br />I RETENTION .D
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />OFFICERIMEMBER EXCLUOED4 ETOR/PARTNETEXCGUTIVE ❑N
<br />NIA
<br />W0201600005078
<br />2/1/2016
<br />2/1/2017
<br />PER ETH
<br />x TA ElR
<br />EL EACHACCIOENT $1,000,000
<br />E. L. DISEASE. EA EMPLOYE $1,000,000
<br />(Mandatory In NH)
<br />If yes, descrlbe w,der
<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 />RIC00147888
<br />RIC00147688
<br />1011/2015
<br />1011/2015
<br />10M12016
<br />1011/2016
<br />Deductible: $1,000 300,000
<br />Deductible: $1,000 200,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlSonal Ramarhe Schedule, may be attached if more space Is required)
<br />Carrier A: Blanket Building Coverage Limit: $4,339,200 /Special Form/ Deductible $1,000 /effective 10-01.2015 to 10-01-2016
<br />Carrier A: Blanket Business Contents Limit: $530,0001 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 prlmary and non-contributory. CG2026 Endorsement attached. Waiver of
<br />Subrogation for Workers Compensation policy applies in favor of certificate holder: Endorsmenl to follow
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana Community Development Agency ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Terri Eggers An AIDL4
<br />20 Civic Center Plaza, M-25 AUTHORIZES REPRESENTATIVE
<br />Santa Ana CA 92701 USA /% 7
<br />AV -
<br />G^' 019882014 ACORD CORPORATION. All rights reserve,
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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