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A c & CERTIFICATE OF LIABILITY INSURANCE
<br />DATDYY Y)
<br />�.--�
<br />12/1/2016
<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(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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />Marie SwaneyFAX
<br />Dealey, Renton & Associates
<br />PHONE
<br />626-644-3070
<br />199 S Los Robles Ave Ste 540
<br />.
<br />Pasadena, CA 91101
<br />E-MAIL . mswaney@dealeyrenton.00m
<br />Lic #0020739
<br />INSURERKS) AFFORDING COVERAGE NAIC 0
<br />INSURER A:TravelersProperty Casualty CoofA 25674
<br />D M ET0 RENTED
<br />PREMISES Me occurrence $1,000,000
<br />INSURED KOACORPOR
<br />INSURERB:Travelers Indemnity Co. of Connecti 25682
<br />KOA Corporation
<br />INSURERC:American Automobile Ins. Co. 21849
<br />1100 Corporate Center #201
<br />Monterey Park, CA 917544
<br />INSURER DACE American Insurance Company 22667
<br />INSURER E:
<br />323-260-4703
<br />INSURER F :
<br />XCU Included -
<br />COVERAGES CERTIFICATE NUMBER- 2035226751 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 />ILSR
<br />TYPE OF INSURANCE
<br />AODLSUBR
<br />INSD
<br />MD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDmYYVYI
<br />POLICY EXP
<br />UAMIDDIYYYY)LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR.
<br />Y
<br />Y
<br />68020751-840
<br />3/13/2016
<br />3/13/2017EACH
<br />OCCURRENCE $1,000,000
<br />D M ET0 RENTED
<br />PREMISES Me occurrence $1,000,000
<br />X
<br />MED EXP (Any one person) $10,000
<br />Contractual Liab
<br />XCU Included -
<br />PERSONAL&ADV INJURY $1,000,000
<br />X
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY PES 1-1 LOC
<br />GENERALAGGREGATE $2,000,000
<br />GEN'L
<br />PRODUCTS - COMP/OP AGG $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BA2A439568
<br />3/13/2016
<br />3/13/2017UUMBINLD61NULL
<br />LIMIT
<br />Ea accident $1,000,000
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per person) $
<br />X
<br />AUTOWNED SCHEDULED
<br />HIREDAUTOS X NON -OWNED
<br />AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident $
<br />$
<br />B
<br />X
<br />UMBRELLA LIABX
<br />OCCUR
<br />Y
<br />Y
<br />6802075LB40
<br />3/13/2016
<br />3/13/2017
<br />EACH OCCURRENCE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $5,000,000
<br />DED X RETENTION $O
<br />$
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY
<br />❑NIA
<br />ER EXCLUDED? F-1
<br />WZP81035047
<br />9/19/2016
<br />9/19/2017
<br />X PER X O_
<br />"'R
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />(Mandatory, in NH)
<br />If yes, describe under
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />DESCRIPTION OF OPERATIONS be.
<br />D
<br />Professional Liability
<br />Claims Made Form
<br />G23631684011
<br />3/13/2016
<br />3/13/2017
<br />$2,000,000 per claim
<br />$2,000,000 Annual Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />General Liability excludes claims arising out of the performance of professional services. Umbrella
<br />Policy is follow -form to underlying GL/AUTO/Employers Liability policies
<br />RE: KOA #MB63110, Santa Ana Metro East TS -- City of Santa Ana, its officers, employees, agents, and
<br />representatives are named as additional insured as respects general & auto liability for claims arising
<br />from the operations of the named insured as required per written contract or agreement. Coverage
<br />See Attached... i
<br />�V161D 13 4 i KAW�O'F/6 rJDo I'2-22jL.mL(o
<br />City of Santa Ana
<br />Attn: Purchasing Division
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />IUI INUllydy VI rrelll
<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 />@ 1988-2014 ACORD CORPORATION.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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