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515A OCCUM•1 OP 10:
<br />ACiOR CERTIFICATE OF LIABILITY INSURANCE DATE: 2120YYYV)
<br />�e.e•--' W212015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIt
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEI
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR1212E
<br />..,PORTANT: If fila certiHcote holder Is on ADDITIONAL INSURED, the pollcy(19S) must be endorsed, If SUBROGATION IS WAIVED,subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement.
<br />A atalemont on this certificate does not confer rights to the
<br />Certificate holder In lieu of such ondorsernont s .
<br />_
<br />PRODUCER
<br />A9ri•Cenlor Insurance Aeency
<br />2850 W. Show Lane, Suite 102
<br />91 , Kim Cameron
<br />Pox ; E gg8-233.0123 Np 658-265.8868
<br />Presno, CA 03719
<br />Anthony Stomatta
<br />pnn klm a rlcenterinsurance,com ----
<br />INSURaR(SIAFFORDING COVERAOR NNON
<br />B
<br />111SURSRAt American Casualt Co Of Readln
<br />INSURED Occu-Med, Ltd,
<br />2121 W. Bullard
<br />Fresno, CA 93711
<br />11490RERBICHIZORS Insurance Co of Amer 31534
<br />IRauRERc:ContinentalCasualty Co. 20443
<br />•--
<br />NEURBRO:
<br />08113)2018
<br />[IN—SURER a L
<br />pgE&IISM3EE enwj qL00,000
<br />NSURERP:
<br />CnVPOAr:FS ❑CRTIFIr AT9 MI IMAIDN'
<br />[iGLTICIf1P1 RLIIAARFA.
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED DELOW 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 W17H RESPECT TO WHICH THIS
<br />CERTIPICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE APPORDEU BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONOITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLNMS.
<br />INV
<br />TYPE OPINBUNANCC
<br />A019
<br />SUIR
<br />POMOYTHIMBER
<br />IMAM
<br />Mlb 11
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS.MADB 0 OCCUR
<br />X
<br />OHF926284704
<br />(1811312016
<br />08113)2018
<br />EACHOCCURRENCE S 2,000,000
<br />pgE&IISM3EE enwj qL00,000
<br />MED ENP one :Bae 6,000
<br />PERSONALSADVINJURY $ 21000,00
<br />GERL AGGREGATE LIM IrAPPLIES PER:
<br />X POLICY ❑ jECT 1.00
<br />OTHER:
<br />GENERAL AGGREGATE 4,000,1100
<br />PRODUCTS-COMP/OP A00 $ 4,000,00
<br />$
<br />Y`
<br />A 0810 LIABILITY
<br />ANYAUTO
<br />ALLOW
<br />AWNED 9CHE1ULEO
<br />AUTOS
<br />HIREDAUTOS X �OSWNEO
<br />OHF926284704
<br />0811312016
<br />(HIM312016
<br />C MBINED8INGLE )MIT $ 2,000,000
<br />80ORY101URY{PArpomm) B
<br />BODILY INJURY Parawldont $
<br />IF dEn $
<br />g
<br />X
<br />UMBRELLA LIAR
<br />EXC98S VAR
<br />X
<br />OCCVR
<br />CLAIMS-I,wOR
<br />0HF026284704
<br />08/1312016
<br />0811312016
<br />EACH OCCURRENCE $ 4,000,00
<br />AGGREGATE $ 4,000,000
<br />OED I ETENTIONS
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYGNS' LIABILITY
<br />ANYPROPRIETORAPARTNERE CVTIVE Vim_
<br />OPPOEMAEMBER EXCLUDED? 1t.L..J.11
<br />(Myond09 dmfIbn NH)
<br />)er
<br />DESCRIPTION OF OPERATIONS Wow
<br />NAA
<br />0430786701
<br />06106/2015
<br />0810612016
<br />X BTA UTE
<br />E.L EACH ACCIDENT $ 1,000,00
<br />el. DISEASE• FA EMPLOYS $ _ 1,000,00
<br />EL DISEASE - POLICY IMIT A 1,00000
<br />C
<br />Professional Web
<br />Clalms Medo
<br />428437060
<br />0012212016
<br />08122/2018
<br />LImIUAgg 6,000,000
<br />Retention 26,00
<br />DaBCRIPTION OFOPBRAnONSTLOCATIONR AVENICLEB (AGGRD fEt, AtldliloNH RomuBe Bebedula, may ha nbohed ff moro epees fe,equlratll
<br />THE CITY OF SANTA ANA ITS OFFICERS AGENTS, VOLUNEERS AND EMPLOYEES ARE
<br />ADDED AS ADDITIONAL INSURED A$ R99PECTS TO OPERAT10hS AND ACTIVITIES OF OR
<br />ON BEHALF OF THE NAMED INSURED PERF% MEO UNDER CONTRACT WITH THE CITU OF
<br />SANTA ANA PER COMPANY FORM 13P0448 01 8, PRIMARY WORDING PER COMPANY FORM
<br />391.1331.
<br />rH a:aAlyrrvll�xnuru: a,TATaa�rrim
<br />ACORD 26 (2014/01)
<br />®1988.2014 ACORD CORPORATION. All rights reserved.p�
<br />Tho ACORD name and logo are roglstored marke of ACORD 6,
<br />0
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />CITY OF SANTA ANA
<br />j 20 CMG CENTER PLAZA
<br />SANTA ANA, CA 92701
<br />THR EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH TNS POLICY PROVISIONS,
<br />AUP109I4E0RAP NG191VATIVII
<br />Anthony Stornetta t R Srr
<br />ACORD 26 (2014/01)
<br />®1988.2014 ACORD CORPORATION. All rights reserved.p�
<br />Tho ACORD name and logo are roglstored marke of ACORD 6,
<br />0
<br />
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