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<br />A°CA?" CERTIFICATE OF LIABILITY INSURANCE
<br />1
<br />DATEcMMi�o,YYYYI
<br />`, , ..-
<br />1 1 012 8/2 01 6
<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 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 />CONTACT
<br />(Niel Chan
<br />Arthur J. Gallagher & Co.
<br />PRONE FAX..... _...�...-----
<br />c rrti. 81/3-539 2300 �A No 818-539 2301
<br />Insurance Brokers of CA. Inc. LIC # 0726293
<br />I
<br />505 N Brand Blvd, Suite 600
<br />E -/(MAIL
<br />rJRE55 .Mei_Chanajg.Cam
<br />..m..
<br />Glendale CA 91203
<br />INSURERgS) AFFORDING COVERAGE. NAIL N
<br />INSURER A :Berkley National Insurance Company 38911
<br />X Sexual Abuse,Llsl:..
<br />X 1MM/3M6y1 ..,_- ....... .... ........
<br />INSURED
<br />INSURER B:New York (Marine And Genera/ Insuran 16608
<br />Interval House
<br />INSURER C Great American Spirit Insurance Cam 33723
<br />P.O. Box 3356
<br />_....... _--
<br />Seal Beach, CA 90740
<br />-INSURER D
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY. PRG- JECT ❑ LCC
<br />INSURER E
<br />INSURER F:
<br />t'.nVFRAr F:S r`.FRTIFIr`ATF NIIIMRFP- 1133428479 RF`VI4ZIr11N hllrMRF=0-
<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 />_..-__�............................-- . .........
<br />(NSR TYPE. OF INSURANCE RD-�P'OL4CY EFF POLICY EXP
<br />LTR (NSD WVD POLICY NUMBER (MMIDDIYYYY MMIDDNYYY LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />HHS8525626-10
<br />10)112016
<br />10/1/2017
<br />EACH OCCURRENCE $1,000,000...
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED__-_
<br />_P4EMISES IEa occurreace�mm,,,,_, ..$100.,000
<br />X Sexual Abuse,Llsl:..
<br />X 1MM/3M6y1 ..,_- ....... .... ........
<br />MED EXP (Airy one person) $5,000
<br />_..
<br />PERSONAL &ADV INJURY $1,000000
<br />GENERAL AGGREGATE $3,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY. PRG- JECT ❑ LCC
<br />PRODUCTS -COMMP.AGO $3,000,000
<br />OTHER:
<br />Professional Liab $1 MM/3MM
<br />AUTOMOBILE
<br />LIABILITY
<br />MBINED tN LE I $
<br />1a accident)
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />'.AUTOS AUTOS
<br />BODILY INJURY Per accident) $
<br />( I
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE .--.._
<br />Fre-r acc'odenf)
<br />$
<br />A
<br />UMBRELLA LIAR OCCUR
<br />HHN 8565362-10
<br />101112016
<br />101112017
<br />EACH OCCURRENCE $2,000,000
<br />_._.....
<br />X
<br />EXCESS LIAR CLAIMS -MADE
<br />....,._-_.._...---- ...... _.
<br />.-......._...
<br />AGGREGATE $2,000,000
<br />DFD X RFTENTION$0
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS" LIABILITY YIN
<br />y
<br />WC201600005078
<br />211/2016
<br />21112017
<br />XPER OTH-
<br />SPATUTE ER .......
<br />ANY PROPRIETORIPARTNEWEXECUTIVE
<br />OFFICERIMEMBEREXCLUDE.D? El
<br />NIA
<br />E.L. EACHACCVDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />- ..-..
<br />(Mandatory lin NH)
<br />If yes, describe ender
<br />_......,_
<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 />Cyber Liability Retro:7/112016
<br />HHS8525626-10
<br />HHS8525626-10
<br />NET1280674
<br />10/112016
<br />10/112016
<br />7/1/2016
<br />1011/2017
<br />1011/2017
<br />71112017
<br />Limit :300,000 Deductible: $11,000
<br />Limit : 300,000 Ded:10,000
<br />Limit/Agg :1,000,000 Retention:$5,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CarherA: Blanket Building Coverage Limit: $4,339,2001 Special Form/ Deductible $1,000 /effective 10-01-2016 to 10-01-2017
<br />Carrier A: Blanket Business Contents Limit: $530,000 /Special Form/ Deductible $1,0001 effective 10-01-2.016 to 10-01-2017
<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.
<br />CERTIFICATE HOLDER CANCFI I ATInm
<br />City Of Santa Ana Community Development Agency
<br />Attn: Terri Eggers
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza, M-25
<br />Santa Ana CA 92701
<br />USA
<br />AUTHORISED REPRESENTATIVE
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<br />1988.2014 ACORD CORPORATION. All rightWieserved'
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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