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INTEDDEM-01 SROSAS <br />DATE (MM/DD/YYYY) <br />CERTIFICATE ®c LIABILITY <br />INSURANCE <br />11/14/2017 <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(ies) 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 CONTACT <br />NAME: <br />Paramount Exclusive Insurance Services, Inc. PHONE FAX <br />16000 Ventura Blvd. #200 (A/C, No, Ext): (818) 986-7283 1 11 (A/C, No):(818) 986-4949 <br />Encino, CA 91436 AE -MAIL <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 />INSR TYPE OF INSURANCE IADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS <br />LTR <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />— <br />CLAIMS MADE OCCUR <br />___ $ <br />DAMAGE TO RENTED <br />PREMIE ? (Ea occurrence. __ $ <br />MED EXP (Any one person) _ $ <br />PERSONAL & ADV INJURY $ <br />5 PER <br />GE N'L AGGREGATEAPPLIES <br />GENERAL AGGREGATE $ <br />POLICY PRO- <br />LOC '�, <br />. � <br />PRODUCTS -COMP/OP AGG $ _.. <br />OTHER: <br />$ <br />AUTOMOBILE LIABILITY' <br />- <br />,. <br />COMBINED SINGLE LIMIT <br />(Ea -accident)........— -� —- _......... ....__.. <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />O WNED SCHEDULED <br />AUTOS ONLY ,AUTOS <br />BODILY INJURY (Per accident) $ _. <br />HIRED NON-pWN p <br />PROPERTY AMAGE <br />(Per $ <br />-_, AUTOS ONLY _. ARMONO <br />accident4 <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE $ <br />EXCESS LIAR CLAIMS MADE' <br />-I, <br />AGGREGATE.._...- $ <br />DED RETENTION $ <br />$ <br />A WORKERS COMPENSATION <br />X <br />',. ERH.. <br />AND EMPLOYERS' LIABILITY <br />Y/N <br />X <br />1877624-2017 09/27/2017 <br />_STATUTE <br />09/27/2018 1,000,000 <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />--.OFFICER/MEMBER EXCLUDED? Y N (A <br />(Mandatory in NH)1,000,000 <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />Ifes, describe under. <br />1000000 <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ <br />i <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />Waiver of Subrogation in favor of City of Santa Ana. <br />REVIEWED BY: d EUNICE HEREDIA (PG Y OF <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza - Ross Annex (M) <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />