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OCCUNb,1_ _OP In, JY
<br />ac ° CERTIFICATE OF I_IABIL n'Y' INSURANCE R06/08120,16n
<br />-OOIDES/2090 _.
<br />THIS CERTIFICATE IS ISSUED AS A MAT"I'ER OF mroRMAT1ON ONLY AND CONFERS NO RIGFIT$ UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED IBY THE POLICIES
<br />BELOW, TI -118 CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW(»EN THE ISSUING INSURER($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />INTI OP RTANT; If the cortifionto holder Is on ADDITIONAL INSURED, LIPS Oolloy(les) must bo endoraod. IP 3UEROGATION IS WAIVED, aubjent Cq
<br />the terms and eondl0ons of the Polley, 0e11aln PDIIaIoS may require an endorsement, A statement Gn NO certificate does not confer rights to tho
<br />certificate holder In /lou of such on torsoment(a),+s,
<br />DUCER
<br />Kim Cameron
<br />Anrl•Centerinsuran,aa A, ancy
<br />2659 W. Shaw Lane, SUltp 702
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<br />J..1AtN,.N
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<br />Froono, CA 93711
<br />In"�a�,(jlDonFarino)aranca.cotn
<br />Awhony Stornotts
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<br />..,_,,,,......_.,.,, INSURERI8I APPQI7bWg9gq El,2AQ_R,_____,__...--...___._..............
<br />$ 2,000,000
<br />&I Citirons Inauraroe Co of Amer
<br />_ _ ___._..._._.__
<br />IwsuRDD Occu•MBcl,Ltd.
<br />INauRaaa,AmorlcanCast, IaliyGooFReading_„
<br />2121 W. Bullard
<br />'"-'_..__..._._...__ _
<br />INSYL'Rt ; Continental Gasuai, Co. 20443
<br />Froeno, CA 93711
<br />.... ....
<br />001'13/2018
<br />,aurim 0-.—_.�.__.._.................................__...._._.,,,...___..,._..., _..__,..........,,.
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<br />& ................._390,000
<br />CO ERA ES CERTIFICATE NUMBER: REVISION NUMB„�,,R;
<br />THIS IS TO CERTIFY THAI" THE POLICIES OF INSURAN05 LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR'fI9E POUCY PERIOD
<br />INDICATED, NOTWITIISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THC INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO All, THE TERMS,
<br />EXCLUSIONS AND CQN01TIP618 OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL) CLAIMS,
<br />pit,fYPR 9PIN8URAN08 mIB WY pDLIDV NO eH DIYYwwwYY MM1llD011 LIMIT$ ^
<br />A
<br />X
<br />00MMERGIAL GENERAL LIABILITY
<br />1?AGi OCCURRENCE
<br />$ 2,000,000
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<br />eLAIMe• AOR [Xj occuR
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<br />X
<br />01-IF926284709
<br />OBl13f2074
<br />001'13/2018
<br />TAM"1t7Mq'E0""'-"""'
<br />,_PP-ti`,P,MISE$SEo oFen31_.
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<br />& ................._390,000
<br />MED CXp (Any ane anon
<br />$ C)1090
<br />PERSONAL_&AOV_W_JU_RY
<br />$ 21000,000
<br />OENBRAi_AGGREGATE
<br />S
<br />GCN'LAGOREOATE
<br />LIM(IIT APPLIES PER;
<br />POLICY ElJIMl^x� LOC
<br />PRODUCTS-CONPIO4!AOG
<br />_ _4,000,000
<br />d_4,000,000
<br />8
<br />AUTOMOBILE LIAW LITY
<br />OrdB > f'7f CITE I ,J1JiT
<br />$ 2a9auoo
<br />f,amvNO
<br />AIx$
<br />ANYAUTO
<br />ONF920204702
<br />00/13/2014
<br />00/13/2016
<br />BODILY INJURY (Pat parson)
<br />a
<br />aLrO$NeD _ AU70SULE0
<br />.....__....._........__._.._...._._..—_
<br />DODILYINJURY(Faraualdant)
<br />$
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<br />UMBRELLA LIAR X OCCUR
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<br />EACH OCCURRENCE
<br />n 4,000,000
<br />aacReaaie
<br />$ 4a0q�AR0
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<br />_�..
<br />eXOH88LIAtl CLAIMeMADE
<br />DHP9262B47o2
<br />0011812014
<br />00/1312096
<br />OEb RETENTION
<br />5
<br />WONNERS COMPENSATION
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<br />AND BAIPLOYERS! VANUTY Y
<br />A
<br />ANY PROPRIE'I'OWPkR7NDECEXECUYIVE I'—'T
<br />NIA
<br />WC4$070GT01
<br />06/06/2016
<br />06106/2016
<br />EACH AGDIDENT
<br />=Ytr
<br />& 1,0 0,000
<br />�1fFICRIUMEMNBR EXC4 OE44
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<br />Meauatorytn NHl
<br />e.tDISEASE GMP{.O1'E$
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<br />00,000
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<br />yna 4
<br />PT10 OPERAt'jCe{JPbolav
<br />FTIQe F OPr O
<br />l;L. DISEASE- PDLIDY tMT
<br />,.1,0
<br />6 1090/009
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<br />Rrofes9i08n1 LlabLlab
<br />426437060
<br />00122/2014
<br />06/2W/.016
<br />LIMRIAgg 6,000,000
<br />Claims Made
<br />Retention 26,000
<br />DESCRIPTION OF OPERATIONS / 1,00ATIONSIVS11049e t0.g0Rq 101, AdtlltlMat ReRIa,Ra Salladulo, renyba allilnhatl Ihuora epees )a rarynlrgU)
<br />THE CITY OF SANTA ANA ITS OFFICERS, AGENTS, VOLUNEERS AND EMPLOYEES ARE
<br />OF THE NAMEDLINSURED PERFORMED CIONTRACT ACTIVITIES
<br />THE CIITY OF
<br />ON BCEHALF UNDER
<br />SANTA ANA PER COMPANY FORM BP0448 0109. PRIMARY WORDING PER COMPANY FORM
<br />391.993'1.
<br />SHOULD ANY OF THE ABOVa=ORIRED POLIGIES BB CANCELLED SBFORR
<br />CITY OF SANTA ANA TI -0B EXPIRATION DATE THBRCOC•, NOTICE WILL FE DELIVERED IN
<br />LAnthony
<br />ANCE WITH THE POLICY PROVISIONS,
<br />20 CIVIC CV.NTRR PLAZA
<br />SANTA ANA,. CA 82701 REFRL'eEN'rATIVH— ""»"`"'»""•"`"
<br />Stornetta sw wM
<br />I..,. raw_ ..,._ t
<br />ID 4980.20'14 AGOIJO CORPORATION. All right 9 reserved,
<br />ACORD 26 (204410'1) The ACORD namo and logo are registered marks of ACORD y�'
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