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THOMHOU-01 VDINH CERTIFICATE OF LIABILITY INSURANCE DATE (M MID DIYYYY) 3/6!2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 Newport Beach, CA - HUB International Insurance Services Inc. 4695 MacArthur Court Suite 600 Newport Beach, CA 92660 CONTACT NAME: PHONE. Ext): (949) 623-3980 (A/(;, No): (949 891-0407 E-MAIL ODD e INSURERS AFFORDING COVERAGE NAIC q INSURER A: Great American Insurance Company 16691 10/03/2017 INSURED INSURER B: State Compensation Insurance Fund of California 35076 INSURER C ;Arch Insurance Company 11150 Thomas House Temporary Shelter INSURER D: PO Box 2737 Garden Grove, CA 92842 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSD SUER LYVD POLICY NUMBER POLICY EFF 0- POLICY EXP (MMIDUrYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCURPAC0594539 X 10/03/2016 10/03/2017 EACH OCCURRENCE 2'000'000 DAMAGE TO RENTED 100,000 PREMISES Ea qcCurrmce $ MED EXP (Ary one erson 5'000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: POLICY ❑ JPELQT LOC OTHER: GENERAL AGGREGATE g 1,000,000 PRODUCTS - CC) MP/OP AGG 1'0001000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUUTOpSW AIJTDS ONLY Ix AUTOS ON LOY PAC0594539 10/03/2016 10/03/2017 COMBINED SINGLE LIMIT 1,000,000 (Fa accident)$ X BODILY INJURY Perperson) $ BODILY INJURY Per accident $ DAMAGE $ Pe�acci _ent $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANY PROPRIETORIPARTNERIEXECUTIVE ❑ OFFICEFMEn NH} EXCLUDED? (MandaE.L. Ifyes, describe under DESCRIPTION OF OPERATIONS below NIA 91432962016 10/01/2016 10/01/2017 X PTR OUTE RH- E.L. EACH ACCIDENT $ 1,000,000 1,000,000 DISEASE - EA EMPLOYEE J E.L. DISEASE - POLICY LIMIT 1,000,000 C Directors & Officers NFP012112200 11/2312016 11/23/2017 $5k Ded / Agg: 1,000,000 OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe affached If more space Is required) 3 Ana, its officers, officials, agents, and employees are additional Insured In regard to General Liability per attached form CG822412101. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Cit of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Terri Eggars 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 ACORD 25 (2016103) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD