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A��R" CERTIFICATE OF LIABILITY INSURANCE
<br />°ATE(MMI°°"YY'
<br />8/29/2016
<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 policy(les) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER Owen -Dunn Insurance Services
<br />1455 Response Road, Suite 260
<br />Sacramento, CA 95815
<br />CONTACT
<br />NAME'
<br />PHONE 916 993-2700 uc No: 916 993-2683
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC0
<br />✓
<br />INSURER A: Sentinel Insurance Company LTD 11000
<br />www,owendunn.com 0522677
<br />INSURED
<br />Citygate Associates, LLC
<br />David DeRoos
<br />INSURER 0; Trumbull Insurance Company 27120
<br />INSURER C: Landmark American Insurance Company 33138
<br />INSURER O'.
<br />2250 E. Bidwell St. #100
<br />NSURERE
<br />Folsom CA 95630
<br />INSURER F:
<br />Cf1VFRAf:FC CFRTIFICATF NHMRER• 11RAa015 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 />/NSR
<br />LTR
<br />rypE OF INSURANCE
<br />I=ADDL
<br />9 M
<br />POLICY NUMBER
<br />MMIDO"YY
<br />MMIDDYYYY
<br />LIMITS
<br />A
<br />�/ COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1✓ OCCUR
<br />✓
<br />✓
<br />57SBAAZ1255
<br />7/15/2016
<br />7/15/2017
<br />EACH OCCURRENCE $ 2,000,000
<br />PREMISES Ea mbU11.nce S 1,000,000
<br />MED EXP (Any one person) $ 10,000
<br />✓ Deductible - $0
<br />PERSONAL &ADV INJURY $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,000
<br />PRODUCTSCOMPIOP AGO $ 4,000,008
<br />POLICY ✓❑ JECOT LOC
<br />Employee Dishonesty $ 50,000
<br />OTHER
<br />I
<br />I
<br />I
<br />A
<br />AUTOMOBILELIABILITY
<br />✓
<br />57SBAAZ1255
<br />7/15/2016
<br />7/15/2017
<br />Eeea deD SINGLE LIMIT $ 2,000000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />✓ AUTOS ONLY AUTOS ONLY
<br />BODILY INJURY (Per accident) $
<br />PR PERTY DAMAGE $
<br />Per accident
<br />$
<br />A
<br />�/
<br />UMBRELLA LIAB
<br />/
<br />OCCUR
<br />57SBAAZ1255
<br />7/15/2016
<br />7/15/2017
<br />EACH OCCURRENCE $ 4000000
<br />AGGREGATE $ 4,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I ✓ RETENTION $10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICERIMEMBER EXCLUDED? ❑N
<br />(Mandatory In NH)
<br />NIA
<br />�/
<br />57WECEU6620
<br />10/1/2015
<br />10/1/2616
<br />✓ STATUTE OTH
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE- EA EMPLOYEE $ 1 000 000
<br />E. L. DISEASE -POLICY LIMIT S 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />C
<br />Professional Liability
<br />LHR828648
<br />2/14/2016
<br />2/14/2017
<br />Aggregate: 2,000,000
<br />Each Claim: 2,000,000
<br />Deductible: $10,000 each claim
<br />Retro Date: 1/6/1999
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
<br />The City of Santa Ana, its officers, agents, employees, representative and designated volunteers are included as additional insureds pursuant
<br />to a signed contract with respects to General Liability and Business Auto as per the terms & conditions of the attached endorsements.
<br />Primary wording applies per the attached endorsement, General Liability and Workers Compensation waiver of subrogation applies per attached.
<br />`"30 Day cancellation endorsement to be issued by carrier.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CitTHE y
<br />ofSanta Ana Finance & Management Services Agency
<br />Center Plaza M-16
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />ACCORDANCE EW THON DTHE POLICY PROVISIONS.ATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic
<br />Santa Ana CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />Shelly Campbell
<br />© 1988-2015 ACORD CORPORATION. r' is reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD �LI" 1
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