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ace�ea® CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIDDIYYYY) <br />�...+� <br />10/3/2016 <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 endorsements . <br />PRODUCER <br />CONTACT <br />vy SoI1Gr-Flynn <br />Wood Gutmann & Bogart <br />License#0679263 <br />PHONE FAX <br />(AIC,No. ENo 714-505-7000 (m,Ns),714-573-1770 -- <br />15901 Red Hill Ave., Suite 100 <br />ADOREE-MAILS vy@wgbib.com <br />Tustin CA 92780 <br />_.INSURERIt S AFFORDING COVERAGE NAIC# <br />_— <br />__......_.__ <br />INSURER A:PhiladelphialndemnitylnsCo. <br />INSURED CGAST66 <br />INSURERS: <br />Coast Live Oak School <br />INSURER z <br />Mark Hay <br />.—.� <br />316 Edgewood Road Q - 1-1201 {� <br />INSURERD <br />Santa Ana CA 92706 <br />INSURERE. <br />INSURER F : <br />COVERAGES CERTIFICATF KIHMRFR• 249180180 REtneTnu 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 _- —. _—__ DDLISUBft.__ <br />LTR TYPE OFIN5URANCE INSDIWVO. POLICY NUMBER POLICY EFF POLICYEXP <br />MMIOCIYYYYI i (MMIDDIWWI LIMITS <br />A iX COMMERCIAL GENERAL LIABILITY <br />PHPK1S31933 9/22/2016 19/22/2017 EACH OCCURRENCE $1,000000 <br />CLAIMS -MADE X OCCUR <br />TE <br />DAMAGETORENPREMISES (Ea occurrD nce) $100 000 <br />o <br />_ <br />- kMED EXP(Arlyoneperaan) $$00 <br />_.. <br />PERSONAL &ADV INJURY $1.000,000 <br />GEN'LAGGREGATE LIMIT APPLIES PER <br />: ! GENERAL AGGREGATE $2,000,000 <br />_ <br />'- <br />X POLICY PRO- Lee <br />_.i JECT <br />__T <br />" PRODUCTS - COMP/OP AGO I $2,000,000 <br />OTHER. <br />Is <br />AUTOMOBILE LIABILITY <br />', "' Ea COMBINEDN L 1 $ <br />1 <br />ANY AUTO <br />• BODILY INJURY person) I$ <br />ALL OWNED SCHEDULED <br />NON OWNED <br />ed�LJ,q BODILY INJURY (Per accident) $ <br />U r - - <br />HIRED AUTOS ' AUTOS <br />•� �`I IPRDPERTY DAMAGE $ <br />ei <br />FJPersodtlem) _ <br />$ <br />UMBRELLA LIAR OCCUR <br />a C� FEACH OCCURRENCE $_ <br />EXCESS LIAR 'CLAIMS -MADE! <br />_ <br />AGGREGATE $ <br />DEAD RETENTION$ <br />ni k$ <br />WORKERS COMPENSATION <br />PER O H <br />AND EMPLOYERS' LIABILITY YINII(D <br />lj (STATUTE_--; ER _ <br />ANY PROPRIET➢RIPARTNEMEXECUTIVE <br />- OFPICERIMEMSER EXCLUDED? <br />i�� ", EL EACH ACCIDENT $ <br />NIA -- ---. _ <br />IMendetory in <br />_, El DISEASE - EA EMPLOYEE, S <br />If and <br />describe <br />- <br />0yy SORPTIONe. <br />OF <br />' OE5CRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT ': $- <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1U1, Additional RemarNa Suhetlu(e, mey ba aaached iE more apace Is requlmMl <br />City of Santa Ana, its officers, agents and employees are named as additional insured on the General <br />Liability per attached PI OLD VS 01 08. Cancellation verbiage as per IL0017 11 98 attached. Primary <br />and Nan -Contributory applies on the General Liability per attached PI OLD VS 01 08, <br />THIS CERTIFICATE SUPERCEDES ANY PREVIOUSLY ISSUED, <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Oily of Santa Ana; Parks, Recreation and Community THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Services Agency ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Carmen Acosta <br />1825 W. Civic Center Drive <br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE <br />01988.2014 ACORD <br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD <br />