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AC RL> CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDDIYYYY)
<br />612112016
<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 require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER TechServe Alliance Services Corp.
<br />1420 King Street; Suite 610
<br />Alexandria, VA 22314
<br />ACT
<br />N M _:
<br />PHO',° NExt: 703-997-4271EAAIc No : 703.997.7727
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />✓
<br />INSURER A: Star Insurance Company 18023
<br />www techservea Ilia nce.org
<br />INSURED
<br />Comdyn Group Inc., The
<br />100 E. Thousand Oaks Blvd.
<br />INSURER B: ProCentury Insurance Company 21903
<br />INSURER C:
<br />INSURER D: National Specialty Insurance Company22608
<br />Suite 284
<br />Thousand Oaks CA 91360
<br />INSURERS:
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 30485891 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 />!NSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />MM1��YYYYY
<br />POLICY
<br />MID IO YYYY
<br />LIMITS
<br />D
<br />�/ COMMERCIALGENERALLIABILITY
<br />✓
<br />NDA0791984
<br />6/15/2016
<br />6/15/2017
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE ❑✓ OCCUR
<br />DAMAGE T
<br />PREM SESOE. occurr0ence $ 1,000,000
<br />MED EXP (Any one parson) $ 10,000
<br />PERSONAL & ADV INJ URY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GFNPRALAGGREGATE $ 2,000,000
<br />✓ POLICY ❑ PROJECT ❑ LOC
<br />PRODUCTS -COMPfOPAGG $ 2,000,000
<br />$
<br />OTHER:
<br />D
<br />AUTOMOBILE
<br />LIABILITY
<br />✓
<br />NDB0791984
<br />6/15/2016
<br />6!1512017
<br />(COaBINEDntSINGLE LIMIT $ 1'000'000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLYAUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Per accident
<br />✓
<br />HIRED NON -OWNED
<br />AUTOS ONLY
<br />P AUTOS ONLY
<br />D
<br />�/
<br />UMBRELLA LIAB
<br />f OCCUR
<br />,/
<br />NDC0791984
<br />8/15/2016
<br />6/15/2017
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED ✓ RETENTION $10,000
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />AND
<br />ANYPROFRITORIPARTNERIEXECUTIVE YIN
<br />t:
<br />WC0791984
<br />6/15/2016
<br />6/15/2017TH-
<br />/15/2017�/
<br />H
<br />STATUTE ET
<br />E.L,EACHACCIDENT $ 1,000,000
<br />OFF ICERWEMBER EXCLUDED? �
<br />(Mandatory In NH)
<br />NIA
<br />E.L. DISEASE- EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POi.ICYLIMIT $ 1,000,000
<br />D
<br />A
<br />E&O/Professional Liab
<br />Crime - 3rd Party Blanket
<br />✓
<br />NDA0791984
<br />CR0791984
<br />6/15/2016
<br />6/15/2016
<br />6/15/2017
<br />6/15/2017
<br />$1,000,000 Ea Claim/$1,000,000 Aggregate
<br />$25,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ana, its Officers, Agents and Employees are Additional Insured as respects to General Liability
<br />per attached CG2010 1093 Additional Insured Endorsement. Should any of the above described policies be cancelled or reduced before the expiration
<br />date thereof, the issuing insurer and/or agent will endeavor to mail 30 days written notice the the Certificate Holder, but failure to do so shall
<br />impose no obligation or liability of any kind upon the insurer, its agents or representatives. v
<br />C:CKI Ir14AIt f1VLLICK I.ANI.tLLAI IUN
<br />City of Santa Ana,
<br />its Officers, Agents, and Employees
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702
<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 t
<br />Mark B, Roberts
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) RVA" The ACORD name and logo are registered marks of ACORD
<br />20485891 1 CoMdyn 1nC 16-17 App CertifLaate I Ji11 Nortan 15/21/2016 8:59;15 Ai (EDT) i Page 1 of 2
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