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OP ID: YC
<br />Ai6 v1 CERTIFICATE OF LIABILITY INSURANCE
<br />yYyj
<br />DATE (16/20Y6
<br />TYPE OF INSURANCEI=
<br />1zw 5no1 s
<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 cortificate 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 confor rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Narver insurance
<br />041 W. Las Tunas Drive
<br />CD TACT
<br />NAM: JuneSamarin
<br />PHONN E t 626.943.2237 aC Hal: 686.299.1010
<br />PO Box 1609
<br />San Gabriel CA 91778.1509
<br />WESLEY HAMPTON HOUSEcR0
<br />EMAIL
<br />ADoREsa; lsamarin(rDnarver com
<br />Oce o • LIEBE-1
<br />INSURERS AFFORDING COVERAGE NAIO0
<br />INSURER A: Sentinel Insurance Company 11000
<br />INSURED Llebert Cassidy Whitmore
<br />6033 W. Century Blvd.
<br />Los Angeles, CA 90045
<br />INSURER R: Federal insurance 20281
<br />INSURERG:As en Specialty Insurance 10717
<br />9993IINSURERD:Colony Insurance Company i'9-99-3--
<br />F-ACH OCCURRENCE $ 2,000,00
<br />NSURER E:
<br />INSURER
<br />INSU ERP:
<br />THIS 19 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 />ILSR
<br />TYPE OF INSURANCEI=
<br />ADD[
<br />SUFS
<br />MY2
<br />POLICY NUMBER
<br />ANDFY
<br />pp ICyy
<br />MIDDIYYYY
<br />LIMITS
<br />A
<br />GENERAL
<br />X
<br />LIABILITY
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE F OCCUR
<br />X
<br />728BAAK0318
<br />12/14/2016
<br />12/14/2017
<br />F-ACH OCCURRENCE $ 2,000,00
<br />D Y IBES o c e ce $ 1,000,000
<br />MED EXP (Any one arson $ 10,000
<br />PERSONAL$ ADV INJURY
<br />GENERALAGGREGATE
<br />GEN'L AGGREGATE
<br />POLICY
<br />LIMIT APPLIES PER:
<br />PROLOC
<br />PRODUCTS-COMP/OP AGOX
<br />puTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />XCOMBINED
<br />M$4,000,00
<br />SINGLE LIMIT
<br />(ED mddent)ALLOWNED
<br />INJURY(Per person)
<br />AUTOSBODILY
<br />BODI LY INJURY(Per waldenl)SCHEpULEDAUTOS
<br />(ERACCDPROPERTY DNT)
<br />A
<br />XHIREDAUTOS
<br />725EAAK0318
<br />12114/2016
<br />1211412017
<br />A
<br />X
<br />NON OWNED AUTOS
<br />728SAAK0318
<br />12/14/2016
<br />12/14/2017
<br />$
<br />$
<br />A
<br />B
<br />C
<br />D
<br />X
<br />UMBRELLA UAB
<br />EXCESS UAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />N/A
<br />I
<br />72SBAAK0318
<br />7176.06.96
<br />LRA9AF816
<br />XPL409238
<br />12!14/2016
<br />04/01/2016
<br />12110/2016
<br />12114/2017
<br />04/01/2017
<br />12/10/2017
<br />EACH OCCURRENCE $ 2,000,000
<br />AGGREGATE $ 2,000,000
<br />DEDUCTIBLE
<br />X RETENTION $ 10,000
<br />WORKERS COMPENSATION
<br />ANO EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICER/MCMDER EXCLUDED?
<br />I andatoryln NH)
<br />(E-yee, deeeflbe un
<br />DSCRIPTION OPERATIONS
<br />PERATIONS boloW
<br />Professlonal Liab.
<br />Professional Llab,
<br />$
<br />$
<br />WCSi'AT - OTH-
<br />X _ E
<br />E. L, EACH ACCIDENT $ 1,000,000
<br />E, L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />F.L. DISEASE. POLICY LIMIT $ 1,000,000
<br />Per Claim 6,000,000
<br />Aggregate 5,000,000
<br />1o1,al InalRred Schedule, If more space Is required)
<br />DESCRIPTION OFOPERATION olde 1LOcpTIna IVENIas IAnaA Additional
<br />Certificate Holder is named as an Additional insured in xegaxda to attached
<br />a
<br />General Liability Form S9 00 08 09 05, Per written contract or agreement.
<br />CERTIFICATE HOLDER r:ANIr CI I ATInKI
<br />CITYSAA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />P.O. Box 1988
<br />�.
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />(01988.2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 26 (2009109) The ACORD name and logo are registered marks of ACORD
<br />Wroved G,IS i\o Forw%_.,,
<br />WCUr1 tum 1/ 11) 7
<br />
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