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ACC>Ra CERTIFICATE OF LIABILITY INSURANCE <br />i ,. <br />oArn IMM DOrr" <br />I I/tnm,7 In/`),7m 7t1IA. <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 have ADDITIONAL INSURED provisions or be endorsed.. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may re'qui're an endorsement. A statement on <br />this certificate does not 'confer rights to the certificate holder In Ileu of such endorsement(s). <br />PRODUCER Lockton Companies <br />444 W. 47th Street, Suite 900 <br />Kansas City 1MOCr4I 12-1905 <br />($16) 960-91I00 <br />tcONTA.T <br />PHONE <br />Pan, A!C Na <br />ADDRESS: <br />AI <br />•I, <br />p <br />COMMERCIAL GENERAL LFABILIY <br />CLAWS•MADE K I. OCCUR <br />INSURERIS) AFFORDING COVERAGE <br />E NAIC M <br />INSURER A..:Zurich American Insurance C'D. rnkSu_n�.l-----� <br />16535 <br />1 000' 000 <br />EACH OCCURRENCE SDAMAGE <br />INSURED BLACK &'VEATC1H CORPORATION <br />1058332 11401 LAMAR <br />INSURER 8: American Zurich InsltranCe Cpm2anv _� <br />40142 <br />INSURERS. <br />A <br />OVERLAND PARK ICS 66211 <br />INSURER a <br />Cornish, Kevin <br />INSURER E: <br />X <br />INSURER F ; <br />PERSONAL a Adv INJURY s 1 000 000 <br />1111FATAIri-J it!'draari=M.rirdn_a <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE, MAY BE ISSUED OR MAY PERTAIN„ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />INSRO <br />LTR <br />TYPE SSP INSURANCE <br />L <br />SUOR <br />�. POLICY EFF <br />POLICY NUMBER MMVD <br />POLICY EXP <br />MWDD <br />LIMITS <br />AI <br />•I, <br />X <br />COMMERCIAL GENERAL LFABILIY <br />CLAWS•MADE K I. OCCUR <br />y <br />N <br />GLO 4641358 11/112016 <br />CLQ 4641367 ', 111112016 <br />1111/2017 <br />11/1/2017 <br />1 000' 000 <br />EACH OCCURRENCE SDAMAGE <br />TO RE <br />PREMISES Ea occurreelm nce. S 300!000 <br />X <br />MED EXP (Any one person) S 10.000 <br />A <br />COI+ITRACI'UAL <br />GLOO139245 II/[/2016 <br />ll/l/2017 <br />X <br />BFPD & C/O & XOU <br />PERSONAL a Adv INJURY s 1 000 000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ,Pp CST _ LOC <br />GENERAL, AGGREGATE s 2.00U00 <br />PRODUCTS - COMPIOP AGO, S 1 '000.000 - <br />OTHER: <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />N <br />N <br />BAP 4641355 (AOS) <br />11/t/2016 <br />1Ill/2017 <br />CS?hSI�INE 1NGL LIMIT$ E xdeat 1 000 000 <br />BODILY INJURY (Per person) S XYXXYXX <br />x <br />ANY AUTO <br />X <br />OWNED <br />AUTOS ONLY AUTOSULED <br />BODILY INJURY 1Par' accident) S xxxxxxx <br />xAUTOS <br />HIRED' NDN -OWNED <br />ONLY X AUTOS ONLY(Per <br />PROPERTY DArr�AGE <br />accident) $ <br />_xyxxxxx <br />S xaxxxx <br />UMBRELLA LEASOCCUR <br />HCLAIM&-MADE <br />NOT APPLICABLE <br />EACH OCCURRENCE S XXX'. xxx <br />AGGREGATE S XXXXXXX <br />EXCESS LIAR <br />OED RETENTIONS <br />S xXXX'xxx <br />BAND <br />A <br />A <br />WORKERS COMPENSATION <br />EMPLDwERs' LIABILITY <br />ANY PROPRIETORJPARTNERFEXECUTIVE YIN <br />OFFICEAIMEMBER VXCLUOED9 - <br />IM4andatoly In NH) <br />NIA <br />N <br />IVC 4641353 AIDS} <br />WC 464 W1&IIIA) <br />IVC 0139244 <br />111112016 <br />11/1)2016 <br />11/1/2016 <br />1111/2017 <br />IIfIl201i <br />111112017 <br />PER OTH- <br />X STATUTE ER <br />_ <br />E -L. EACH ACCIDENT $ 11?00000 '' <br />E.L.. DISEASE - EA EMPLOYE $1-00-00-0— <br />It yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />— <br />E.L. DISEASE - POLICY LIMIT S. 1 000 0 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I V61, ICLES (ACORD Lal, Additronai Remarks Schedule, may be attached It mare speea is roq,uiledl <br />B&V Project # 188958.01 DO, Consultant Agreement The City' of'Santa Alga, California, its officer, employees, agents, volunteers and representatives are <br />included as Additional Insureds on the General Liability Policy as required by written contract. <br />13635763 <br />City of Santa Ana, Califclmia <br />220 S, Daisy Avenue (IVi-85) <br />Santa Ana, CA 92703 <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 />AUTHORI=D <br />J 19582015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />P' <br />