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1-1-1-01IN 0
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY)
<br />TF 12�20/20113
<br />S 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 13 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 andarsement(s).
<br />PRODUCER CoRT
<br />Crrurnemial, Lines NAMEA� CT R
<br />o- onald RodrIguez
<br />- 213-253-6700 PHONE FAX
<br />(A/C, No. Ext)� 81 8-447-2011 4 .... (AIC , Not: 866-968-5687
<br />Wells Fargo FnSIJFcIFIGB SeirvIcas, Inc. - CA Lic4: OD08408 P-MAIL
<br />ADDRESS: ron. rod riguez@w(-,,Ilsta rgo corn
<br />333 S. Grand
<br />INSURER(S) AFFORDING COVERAGE
<br />Los Angeles, CA 90071 NAIC 4
<br />.... . ... . ..... INSURER A � Philadelphia inclerinnity insurance Company 18058
<br />..- I P ---
<br />INSURER B:. Employers Assurance Company 25402
<br />Discovery Science Center of Orange GOUnty INSURER
<br />URER C : I
<br />dba Discovery Cube Orange County . . . ... C-I ... ...... .. -
<br />WSURER D
<br />2500 N. Main Street INSURER E:
<br />Sarila Ana, CA 92705 .. . .... .... . ......... .... . . ........
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 11200600 REVISION NUMBER: See below
<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 />CER FIRCA I E MAY BE ISSUED OR MAY PER -FAIN, 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 E . ... . ...... . .. AD15L s0ak POLICY .. EF . F ... . ... ....
<br />LTR TYPE Or INS URANC VQ p
<br />POLICY NUMEIF nR
<br />UMLEgLan _RM DWY LIMITS
<br />X COMMERCIAL GENERAL LIABILITV L X —yy1
<br />A I x PHPI<1590101 12/15/2016 7/11/2018 EACH OCCURRENCE i s 1000000
<br />I OCCUR IYA191AGE TO RENTEo
<br />x
<br />CLAIMS-MAOE PREMISES jEa occurrence)_. 1 0100000
<br />...... . . . .. ..... .. ME. D EXP (Any one person) i S 5000
<br />A PERSONA[ &ADVINJIURY S 1 000'D00
<br />GF!N't AGGREGATE I WIT APPIAES PER,: GENERAL AGGREGATE 2000,000
<br />PRODUCTS - CP�OP AGG 2
<br />x p 0 1, r y I 0C OIVI000000
<br />FIP
<br />M Abugeg0d�t,,11 ion
<br />A AUTOMOBILE LIABILITY COMBINED SINGLE UMIT
<br />X . ANY AUTO Ea
<br />12/15/2016 711/2018 1 '00 0 - 0 - 0 1 a
<br />BUMLY I4JURY (her persc)ii)
<br />OWNED SCHEDIJIFF)
<br />AW-OS A,Q ;T-,-, 1"nn1y INI'➢l IPYrP,"
<br />IVRED OWNED . ..... .
<br />X ON �,Y LY
<br />AUTOS AUTOS ONLY S
<br />D�' ON NON
<br />x :UM;BRELLCA;L1A�B x U
<br />A OCCUR PHUB567098 1211512016 71112018 EACH OCCURRENCE I I ODO,000
<br />EXCESS LIAS
<br />CLAINIS-MADE: AGGREGATE S 11,000,000
<br />0 'Lo
<br />ED RETFN1ION,5
<br />WORKERS COMPENSATION PER OFH
<br />---T4101117 s
<br />B AND EMPLOYERS'LIABILITY EIG1453813-04 04/01/16
<br />-T0RWARTNFR.IkALCU FIVE 1 000,000
<br />ANYPRC)PRIL YIN LK!U.TE .,i. L�R — ----------
<br />oFFICEWMEMBERE"XGLUDED? F—N NIA El, EACH ACCIDENT
<br />(Mandatory In NH)
<br />If yes. descrilrn, under E.L. DISEASE - EA EMPLOYrF,1_1_ 1,000 000
<br />DESCRIPTION OF CPERATION', ILlow
<br />-1 E.L.DISEASE , POLICY LIMIT S 1000101
<br />44
<br />)ESCRIPTION OF OPERATIONS f LCCAJ1ONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attar ce its required)
<br />The City of Santa Aria, Parks, Recreation and Community Services Agency is includ 11 d for General Liablity as required by written
<br />contract.
<br />'ERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana, Its officers, agents, and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Parks, Recreation arid Community Services Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza ACCORDANCE' ITH THE POLICY PROVISIONS,
<br />Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE
<br />.CORD 25 (2016103)
<br />The ACORD name and logo are registered marks of ACORD Cc 1988-2015 ACORD CORPORATION. All rights reserved.
<br />
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