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OP ID: YC <br />14C:" M DATE (MMIDDIYYYY) <br />CERTIFICATE OF LIABILITY INSURANCE 11/2812017 <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 endorsement(s). <br />PRODUCER <br />CONTACT <br />NAME. June Samarin <br />Narver Insurance <br />641 W. Las Tunas Drive <br />PHO <br />(ALPNE_N0 Ext): 626-943-2237 . .... ........ .... . ... 16-299-1010 <br />PO Box 1509 <br />E-MAIL <br />isamarin@ narver.com <br />San Gabriel, CA 91 77 8-1 50 9 <br />WESLEY HAMPTON HOUSE <br />.,�Dqgss <br />PRODUCER <br />CUSTOMER ID #: LIEGE -1 <br />INSURERS) AFFORDING COVERAGE <br />NAIL 4 <br />INSURED Liebert Cassidy Whitmore <br />INSURER A :Sentinel lnsuranceq�pan11000 <br />12/14/2018 <br />6033 W. Century Blvd. <br />INSURERS: Federal Insurance <br />20281 <br />Los Angeles, CA 90046 <br />INSURER C: Aspen Specialty Insurance <br />10717 <br />INSURER D: Peleus Insurance Company <br />-PREMISES <br />MED EXP (Any one persor) <br />_INSURER E: <br />INSURER F : <br />COVERAGES CERTIFICATE NUMBER: REVISION 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 PE OF INSURANCE ADDLnn - POLICY .. .. .. . N .. UMBER POLICY EFF POLICY EXP LIMITS <br />TY INSR wvn(MMIDDfYYYY) (MMIDDfYYYY) <br />.LTR <br />GENERAL LLABIL17Y <br />EACH OCCURRENCE <br />2,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />X <br />72SBAAK0318 <br />1211412017 <br />12/14/2018 <br />DAMAGE TO RENTE03 <br />tEa1,000,00 <br />CLAIMS -MADE OCCUR <br />-PREMISES <br />MED EXP (Any one persor) <br />. . .. .. ........ ...... <br />.5 10,000 <br />PERSONAL & ADV INJURY <br />S 2,000,000 <br />GENERAL AGGREGATE <br />4,000,000 <br />-- ---- <br />PRODUCTS - COMPIOP AGO <br />$ 4,000,00 <br />GIN'L AGGREGATE LIMIT APPLIES PER <br />X0 <br />L� POLICY PRO OC OC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE <br />S 2,000,000 <br />(Ea accident) <br />ANY AUTO <br />BODILY INJURY (Per person) <br />S <br />ALL OWNED ALTOS <br />60DILY INJURY [Per acdcant) <br />$ <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE <br />A <br />X <br />HIRED AUTOS <br />72SBAAK0318 <br />12114/2017 <br />12/14/2018 <br />(PER ACCIDENT) <br />A <br />X <br />NON-OWNFD AuTos <br />72SBAAK0318 <br />12114/2017 <br />12114=18 <br />X <br />UMBRELLA LIAR X OCCUR <br />I <br />EACH OCCURRENCE_ 1___ 2,000,000 <br />AGGREGATE $ 2,000,000 <br />A <br />EXCESS LIAR CLAIMS-10ADE <br />... . . ....... - <br />72SBAAK0318 <br />1211412017 <br />12114/2018 <br />.. ........ — <br />DEDUCTIBLE <br />X <br />RETENTION S 10,000 <br />WORKERS COMPENSATION <br />PC STATU- OER <br />X �Q <br />AND EMPLOYERS' LIABILITY YIN <br />_ Y MT <br />rs <br />B <br />ANY PROPRIFTOR)PARTNrR�EXECUTIVE <br />lin <br />14101121111 <br />0410112011 <br />E.L. EACH ACCIDENT 1,000,000 <br />OFFICERWEMBER EXCLUDED? <br />(MandataryNHI <br />N I A <br />�7175"15-95 <br />E.L. DISEASE - EA EMPLOYEErS 1,000,000 <br />If yes, descnbe under <br />DESCRIPTION OF OPERATION'S below <br />E.L. DISEASE - POLICY LIMIT 0-0 <br />C C <br />[ <br />Professional Liab. <br />1211012�017 <br />12110M18 <br />Per Claim 6,000,000 <br />D <br />Professional <br />essional Liab. <br />�LRA9AF817 <br />XPL409238 <br />Aggregate 5,000,000 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES (Attach ACORD 1111, Additional Remarks Schedule, if more space is required) 11111-IROVEDASTO FORM <br />Certificate Holder is named as an Additional Insured in ret to attached <br />General Liability Form SS OO 08 04 05, per written contrac or agreement. <br />City of Santa Ana <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ACORD 25 (2009/09) <br />CITYSAA <br />cri t-1. I%UNNIIII <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 />AUTHORIZED REPRESENTATIVE <br />Q 1988-2009 ACORD CORPORATION. All rights reserved, <br />The ACORD name and logo are registered marks of ACORD <br />