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HOLCO-1 OP ID: ALA
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />DATE/0712 Y41 7
<br />02107!27
<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 />Partee Insurance Assoc.,lnc.
<br />License#0786033
<br />584 S. Grand Avenue
<br />Covina, CA 91724-3409
<br />CONTACT
<br />NAME:
<br />aWCNMo. Ext: Fvc No:
<br />E-MAIL
<br />ADDRESS:
<br />X COMMERCIAL GENERAL LIABIUTY
<br />Wayne M. Partee CIC, CWCA
<br />INSURER(S) AFFORDING COVERAGE MAIC #
<br />INSURER A: Ohio Security Insurance Co
<br />INSURED HdL Coren and Cone
<br />1340 Valley Vista Dr# 120
<br />Diamond Bar, CA 91765
<br />INSURERB:American Fire and Casualty Co
<br />INSURERC:Twin City Fire Insurance Co.
<br />CLAIMS -MADE Fx] OCCUR
<br />X
<br />INSURER D:
<br />INSURER E:
<br />111151201$
<br />INSURER F:
<br />pAE TED
<br />MGEs Ea occurrence $ 2,000,000
<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 />!LTR
<br />TYPE OF INSURANCE
<br />INSDL
<br />WVD
<br />POLICY NUMBER
<br />MMIDDfYSUBR POLICY YYY FF
<br />MMI�IDIYYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABIUTY
<br />EACH OCCURRENCE $ 2,000,000
<br />CLAIMS -MADE Fx] OCCUR
<br />X
<br />X
<br />BZ856380327
<br />111151201$
<br />1111512017
<br />pAE TED
<br />MGEs Ea occurrence $ 2,000,000
<br />MED EXP (Any one person) $ 15,000
<br />PERSONAL & ADV INJURY $ Included
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 4,000,000
<br />X POLICY 1-1PRO.7 LOC
<br />PRODUCTS - COMPIOP AGG $ 4,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident $ 1,000,000
<br />A
<br />ANY AUTO
<br />X
<br />X
<br />BAS66380327
<br />11/1512016
<br />11/15/2017
<br />BODILY INJURY (Per person) $
<br />A" OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Par accident) $
<br />X
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Per accident $
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />AGGREGATE $ 1,000,000
<br />B
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />USA56380327
<br />11/15/2016
<br />11/1512017
<br />DED I X I RETENTION$ 14,440
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN
<br />OFFICEWIVEMBER EXCLUDED? ❑
<br />(Mandatory in NH)
<br />N I A
<br />X
<br />XWS66380327
<br />11/15/2016
<br />11/15/2017
<br />X STATUTE ER H
<br />E,L,EACH ACC IDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />C
<br />Professional
<br />72PGO260349
<br />11/1512016
<br />11/16/2017
<br />LIMIT 2,000,000
<br />CLAIMS MADE FORM
<br />RETRO DATE 211612003
<br />DED 25,000
<br />DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />*30 day notice of cancellation, 10 days for nonpayment. �� 1'2-q7The City of Santa Ana, its officers, em loyeeS and a ents are named
<br />additional insured as respects to the General Liabili� & Auto Liability.
<br />Waiver of Subrogation applies to the General Liability, Auto Liability &
<br />Workers Compensation.
<br />APPROV
<br />, I '-" d' I - , 'a"
<br />1
<br />CERTIFICATE HOLDER CANCELLATION U _
<br />CITYSAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES ElE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014101)
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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