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A� o® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE 08/2 /201YYY)
<br />08/26/2016
<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 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 endorsement(s).
<br />PRODUCER 1-414-443-0000
<br />Hays Companies of Wisconsin, Inc.
<br />CONTACT
<br />NAME:PHONE
<br />FAX
<br />LAIC. Noo at: AIC No:
<br />1200 North Mayfair Road, Suite 100
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE HAICM
<br />Milwaukee, WI 53226
<br />INSURER A: NATIONAL FIRE INS CO OF HARTFORD 20478
<br />01/01/1
<br />INSURED
<br />Hagerty Consulting, Inc.
<br />INSURER B: CONTINENTAL CAS CO 20443
<br />INSURER C: VALLEY FORGE INS CO 20508
<br />INSURER D: UNDERWRITERS AT LLOYDS-BEAZLEY 32727
<br />1618 Orrington Avenue, Suite 201
<br />INSURER E:
<br />Evanston, IL 60201
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 47667648 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/YYYY
<br />POLICY EXP
<br />MMICHNYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />6023741069
<br />01/01/1
<br />01/01/17
<br />EACHOCCURRENE $1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />PREMIDAMAGETO.Eocbm 100,000
<br />PREMISES Ea occurre ca $
<br />MED EXPAny one person) $10,000
<br />CLAIMS -MADE OCCUR
<br />PERSONAL &ADV INJURY $1,000,000
<br />GENERAL AGGREGATE $2,000,000
<br />GEN'L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS � COMPIOP AGO $2,000,000
<br />X I POLICY
<br />PRO-JECT F7] LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />6023741055
<br />01/01/1
<br />01/01/17
<br />COMBINED SINGLE LIMIT
<br />Ea accident 1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY(Peraccident $
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />B
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />6023741072
<br />01/01/1
<br />01/01/17
<br />EACH OCCURRENCE $ 1,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $ 1,000,000
<br />DED I X RETENTION$ 10, 000
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YI N
<br />ANY PROPRIETORIPARTNEWEXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />6023741041 (AOS)
<br />01/01/1
<br />01/01/17
<br />X I WCSTATU- OTH-
<br />E.L. EACH ACCIDENT $ 500,000
<br />E, L. DISEASE � EA EMPLOYE$ 500,000
<br />(Mandatary in NH)
<br />If you, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 560:2 0 0 , 00 0
<br />C
<br />WC (CA)
<br />6023741086
<br />O1 O1 1
<br />51/51/17
<br />EaAcc EaEE Po L m 1,000,000
<br />D
<br />Professional Liability
<br />W17828160201
<br />O1/O1/1
<br />01/01/17
<br />Ea Claim/Agg 2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: Anaheim/Santa Ana Urban Area (ASAUA) Homeland Security Regional Training Exercise Program
<br />The City of Santa Ana, it officers, employees, agents and representatives are additional insured on above referenced
<br />policy where required by written contract. General Liability is Primary and Noncontributory. A 30 day notice of
<br />cancellation/non-renewal for any reason other than for non-payment of premium will be provided.
<br />CERTIFICATE HOLDER CANCELLATION
<br />© 1988-2010 ACOR R O Z A I reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORQ-,fhalas SEP 1 2
<br />47667648
<br />BY: _
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />The City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />Q..P) ,�(
<br />USA
<br />A
<br />© 1988-2010 ACOR R O Z A I reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORQ-,fhalas SEP 1 2
<br />47667648
<br />BY: _
<br />
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