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271069
<br />,4�o�rcv� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />12/20/2016
<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(ies) 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
<br />CONTACT
<br />NAME: Ronald Rodriguez
<br />Commercial Lines - 213-253-6700
<br />PHONE 818-447-2014 FAX 866 968 5687
<br />A/C No Ext :AIC No
<br />Wells Fargo Insurance Services, Inc. - CA Lic#: OD08408
<br />E-MAIL
<br />ADDRESS: ron.rodri uez@wellsfar o.com
<br />333 S. Grand
<br />DAMAGE TO RENTED
<br />_ INSURER(S)AFFORDING COVERAGE NAIC #
<br />Los Angeles, CA 90071
<br />INSURERA: Philadelphia Indemnity Insurance Company
<br />18058
<br />INSURED
<br />INSURER B: Employers Assurance Company
<br />25402
<br />Discovery Science Center of Orange County
<br />PREMISES Eauc.urren.-
<br />—.._....1..-,-0--0-0,00-0 ------.------ - ---....
<br />INSURER C
<br />2500 North Main Street
<br />INSURER D:
<br />S 5,000
<br />Santa Ana, CA 92705
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />INSURER E: -__.....-_---
<br />----
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 11200594 RFVISIr'1N NI IMRFR- S,aa hPln-
<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 AD SUER POLICY EFF POLICY EXP
<br />LTR TYPE OF INSURANCE I D WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />__....
<br />X
<br />PHPK1590101
<br />12/15/2016
<br />7/1/2018
<br />EACH OCCURRENCES
<br />1,000,000
<br />DAMAGE TO RENTED
<br />- -- --------
<br />CLAIMS -MADE OCCUR
<br />PREMISES Eauc.urren.-
<br />—.._....1..-,-0--0-0,00-0 ------.------ - ---....
<br />MED EXP (Any one person)
<br />S 5,000
<br />PERSONAL & ADV INJURY
<br />S 1,000,000
<br />ATLIMIT PER
<br />GENERAL AGGREGATE-----
<br />2,000,000
<br />XEN
<br />,
<br />POOLICY❑ LOC
<br />PRODUCTS - COMP/OP AGG
<br />..---- —CS-------...__---
<br />._----
<br />... 2,000,000
<br />Sexual Abuse/Molestation
<br />--
<br />-
<br />S Included
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />PHPK1590101
<br />12/15/2016
<br />7/1/201$
<br />EaaBcdeDf51NGLELIMIT
<br />g 1,000,000)
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />----------1�---------------
<br />! S
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY Per accident
<br />( )
<br />I S
<br />X
<br />HIRED X� NON -OWNED
<br />PROPERTY DAMAGE
<br />AUTOS ONLY AUTOS ONLY
<br />Per a.o dent)j
<br />S
<br />$
<br />A
<br />X
<br />UMBRELLA
<br />X
<br />(
<br />f OCCUR
<br />PHUB567098
<br />12/15/2016
<br />7/1/2018
<br />EACH OCCURRENCE
<br />11,000,000
<br />EXCESS LIAB
<br />!
<br />,CLAIMS -MADE
<br />AGGREGATE
<br />S 11,000,000
<br />�
<br />DED RETENTIONS
<br />—....
<br />S
<br />B
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />EIG1453813-04
<br />04/01/16
<br />04/01/17
<br />PER OTH-
<br />X STATUTE ER H-
<br />Y / N
<br />E.L. EACH ACCIDENT
<br />-----
<br />S 1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT j
<br />S 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />�
<br />I
<br />I
<br />i
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
<br />The City of Santa Ana is included as Additional Insured for General Liability as required by written contract.
<br />�REVPi EUNICE HEREDIA (PG { OF _J._...
<br />_.___._:._J
<br />City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Public Works Agency, M-21 ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />P O Box 1988 AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702`
<br />I ne AGuKii name and logo are registered marks of ACORD O 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03)
<br />
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