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..-""'""r♦ WOMEN -3 OF ID: <br />CERTIFICATE OF LIABILITY INSURANCE DATE tMMiDD YYYy <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(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 />Commercial Lines <br />794.447.0011 <br />INSURED <br />92832 <br />of CA <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 <br />THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Daniel Perez <br />L R TYPE OF INSURANCE MWnRX POLICY NUMBER PDM OtY YY <br />LIMBS <br />B - X I COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,00 <br />CLAMS -MADE [X X 01801835NP0 0910112016 0910112016 <br />PREMISES Eaoocdc " <br />$ 500,00 <br />-..... <br />MED EXP(An cme person) <br />$ 20,000 <br />PERSONAL&ADV INJURY <br />$ 1'000,00 <br />GEN1 AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />S 2r0ODr000 <br />X POLICY a JECT [7 LOC <br />PRODUCTS-COMP/OPAGG <br />$ 2r000rOOO <br />AUTOMOBILE <br />LIABILITY <br />COMBINED LI <br />Ee aceldenl <br />$ 11000,000 <br />B <br />ANYAU'r0 20150163SNPO 09/01/2015 0910112010 <br />BODILY INJURY (Per person) <br />$ <br />JX <br />AUTOS ALLOWNED AUTOSULED <br />BODILY INJURY (Per acdconh <br />$ <br />HIRED AUTOS NON-0WNED <br />AUTOS <br />PROPERTYDAMAGE <br />Per acoldenl <br />X <br />UMBRELLA LASX bCGUR <br />EACH OCCURRENCE <br />$ 5,000,00 <br />8 <br />Extassuks F7 GLAMSINADE 201501835UMBNPO 0910172015 0910112016 <br />AGGREGATE <br />$ 51000,000 <br />$ <br />DEO RETENTIONS <br />WORNBRSCOMPENSATION <br />PER OTH- <br />TE <br />X <br />ANDaMPLAYERS'LIABILITY YIN <br />STATUTEL_J EOR <br />ANY PROPRIETOWPARTNERIEXECUTIVE � 0201600006441 03/2812096 03/2812019 <br />E.L. EACH ACCIDENT <br />$ 1r000r004 <br />OFFJOERIMEMBER EXCLUDED? NIA <br />L' 1 <br />.. <br />O,ylondomfy In NPN) <br />E.L. DISEASE -EA EMPLOYE <br />$ 1,000,000 <br />OEBGRIF+1ON OtF APERATIONS beIOW <br />E.L. DISEASE -POLICY LIMIT <br />$ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLRS (ACORD 101, Additional Romnrke Schedule, may be attached if mare r"Q010 required) <br />City of Santa Ana, its officers, agents employees and volunteers are named <br />as additional insureds as respeeta to the general liability policy limits <br />per endorsement CC2012 attached to the ggolicy with Coverage primary and <br />non-contributory per endorsement N1ACE61 attached to the policy. <br />CERTIFICATE HOLDER CANCELLATION <br />CITYS10 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana1ESG <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Daniel Perez <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />PO Box 1988, M-25 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />61988.2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />