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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MWDD/YYYY)
<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 />Ierfoord A Marsh & McLennan Agency LLC Company
<br />Central Park Avenue
<br />1340
<br />nia Beach VA 23462
<br />INSURED
<br />Ph# 559-271-6852
<br />us, Suite 108
<br />COVERAGES CFRTIFICATF NI IMRrm- 417421056 D5%1!Sl at PII IaaGOD.
<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 />TYp OFADDLISUBS
<br />INSD
<br />D
<br />POLICY NUMBER
<br />POLICY EFF
<br />MWDDIYYYY
<br />POLICY EXP
<br />DO
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />_ CLAIMS -MADE OX OCCUREms
<br />Y
<br />Y
<br />CPOS82903806
<br />10/31/2016
<br />10/31/2017
<br />EACH OCCURRENCE
<br />$1_000,000
<br />RENTED^
<br />PREMISES Ea occunence
<br />$1,000,000
<br />MED EXP (Ary one persons
<br />$10,000
<br />.—..._....-_...._
<br />PERSONAL ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />R
<br />POLICY El PECTP LOC
<br />J
<br />_&
<br />GENERALAGGREGATE
<br />$2,000,000
<br />PRODUCTS-COMP/OP AGG
<br />$2,000000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BAP982902106
<br />10/31/2016
<br />10/3112017Fa
<br />a¢itlent
<br />$1,000,000
<br />X
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />AUT8S ED qSUTOSULED
<br />NON INED
<br />HIREDAUTOS HX AUTOS
<br />BODILY INJURY(PeraccMem)
<br />$
<br />PROPER D GE
<br />Peraxidsrl
<br />$
<br />$
<br />B
<br />C
<br />X
<br />X
<br />UMBRELLA UAB I X I
<br />EXCESS LIAR
<br />...._
<br />OCCUR
<br />CIAIM$-MADE
<br />AUC982907906
<br />52280011369
<br />1013112016
<br />10131/2016
<br />10/31/2017
<br />1013112017---
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />OED RETENTION$
<br />10,000,000
<br />$Excess
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/ N
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE El
<br />OFFICER/MEMBER EXCLUDED?
<br />y
<br />WC982903906
<br />10/31/2016
<br />10/31/2017
<br />PER OTH-
<br />X` STATIn',E ,-,T_
<br />E.L. EACH ACCIDENT
<br />_
<br />$1,008000
<br />E.L_DISEASE -EA EMPLOYCd
<br />--
<br />$1,000,000
<br />(Mandatory In NH)
<br />If yee desalba under
<br />DESG�RIPTIONOFOPERATIONSbelow
<br />—
<br />E.L. DISEASE -POLICY LIMIT
<br />—
<br />$1,000,000
<br />E
<br />F
<br />Professional Llab(E&O)
<br />Crime
<br />MPP9D3283601
<br />BDR1035845
<br />10/31/2016
<br />10/31/2014
<br />10/3112017
<br />10131/2017
<br />$5,000,GOOeach claim $5,000,00OAlKie
<br />$5,000,000 Limit $25,000 Ded
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Receerss Schedule, may be attached If more space Is required)
<br />Per the cancellation wording listed on this form, the policy provisions include at least 30 days notice
<br />of cancellation except for non-payment of premium.
<br />The City of Santa Ana, its agents, officers, servants and employees are named as additional insureds
<br />under the General Liability policy with respect to the operations and work performed by the named
<br />insured as required by contract.
<br />City of Santa Ana
<br />Attn: Finance Director
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702-1988Ri APPROVE
<br />ACORD 25 (2014/01)
<br />rCa 1 f ry
<br />hy.' n
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />y�r
<br />©1
<br />The ACORD name and logo are registered marks of ACORD
<br />riahts reserved.
<br />
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