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BLUEMANA2 GINHQDEN
<br />CERTIFICATE. OF LIABILITY INSURANCE 4ATE(Mzlzz1201YYY)
<br />zalr _
<br />THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT5: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 policyiies) 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 License It OG19762 CONTACT
<br />NAME:
<br />Momentous Insurance Brokerage Inc PHONE i31i3 933-2700 FAX $18
<br />5990 Sepulveda Blvd., #660 .(ArC, No, Ext): t ) (Arc, Nn): () 933-2701
<br />Van Nuys, CA 91411 E-MAIL
<br />y a ADDRESS,
<br />INSURER(S) AFFORDING COVERAGE NA1C N
<br />INSURERA: Philadelphia Indemnity Insurance! Company 18058
<br />INSURED
<br />INSURER B: State Compensation Insurance Fund -MAIN '35076
<br />Blueray Management LLC
<br />INSURER C:Sentinel Insurance Company 11000
<br />P.O. Box 12529
<br />INSURER D
<br />Newport Beach, CA 92668
<br />INSURER E :
<br />COVERAGES CFRTIGICOTF NI InARPR- Dr,11101^wi wnreeocu.
<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
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,.
<br />LTR TYPE QP INSURANCE ADPI. SUER.
<br />INSD WVD POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MMIDONYYY MMIDDNYYY LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $
<br />2,000,000
<br />CLAIMS -MADE X OCCUR PHPK1446088
<br />03/24/2016 03124/2017 DAMAGE TES ERaNTED
<br />ccu ence) $
<br />100,000
<br />- - .. ..
<br />MED EXP (Any one person) $
<br />0
<br />- - - -
<br />PCRSONAL&AOV INJURY $
<br />2,000,000
<br />GEN`LAGGREGA_TELIMITAPPLIHSPER;
<br />GENERAL AGGREGATE: $
<br />4,000,000
<br />POLICY - PRO.
<br />JECT _ . LOG
<br />PRODUCTS - COMPIOP AGO 5
<br />4,000,000
<br />OTHER:
<br />_ $
<br />AUTOMOBILE LIABILITY
<br />COMBINED 110LE LIMIT
<br />1,000,000
<br />A X ANYAU70 PHPK1446008
<br />(Ea accident)
<br />03/2412016 03124/2017 BODILY INJURY (Per person) $
<br />ALL OWNED X SCHEDULED -
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident $
<br />( 1
<br />X NON -OWNED
<br />HIRED AVrOS AUTOS
<br />PROPERTY DAMAGE •
<br />(Perseddent) $
<br />UMBRELLA LIAO OCCUR
<br />EACH OCCURRENCE g
<br />EXC698 LIAB CLAIMS -MADE
<br />' AGGREGATE $
<br />_ DEL RETENTION 5
<br />S
<br />WORRIERS _
<br />- X PER H
<br />AND EMPLOYdttS'LtABILITY YIN
<br />ATUTE ER
<br />STATUTE
<br />B - ANY PROPRIETOWPARTNERIEXECUTIVE 9201107-16
<br />12/23/2016 0510112017 E.L. EACH ACCIDENT s
<br />1,000,000
<br />OFFICERIMEMBt=R EXCLUDED?:NIA
<br />(MandatnrylnNH)
<br />E.L. DISEASE - EA EMPLOYEE S
<br />1,000,000
<br />Les, describe under
<br />-
<br />DESCRIPTION OF OPERA71gN5 below
<br />E,L• DIt3EASE -POLICY LIMIT $
<br />1,000,000
<br />C :Property 72SSAAROBSI
<br />03/15/2016 03115/2017 BPP
<br />50,000
<br />C :Property 72SBAAR9861
<br />03/15/2016 0311512017 Deductible
<br />1,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 1D1, Addnlonal Remarks Schedule, may be attached If more space Is required]
<br />Certificate holder Is named as additional Insured per the attached endorsements. Primary and non contributory endorseme t attached.
<br />e, - '(°d•
<br />—•,—• • • •• • �• • • ••• • ••.•�••" • Y1..f�tIYVCLLH i lV3V �� V �— •w
<br />City of Santa Ana Parks, Recreation & Community
<br />Services Agency
<br />1825 W. Civic Center
<br />Santa Ana, CA 92701
<br />SHOULD ANY OFTHE AHOV 3tOIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DAME THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Ls 1attts-ZU14 AGUKV CORPORATION, All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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