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271069
<br />0 CERTIFICATE OF LIABILITY INSURANCE
<br />DAT2/20/2OIYYYY)
<br />12r2ar�a 1 s
<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 aloes not confer rights to the certificate holder in lieu of such endorsement S),
<br />PRODUCER
<br />CONTACT
<br />NAME. Rodriguez
<br />Commercial Lines - 213-253-6700
<br />PHDNE FAX —
<br />AIe o. Exti: 81 B-447-2014 WC. No., 806-968-5687
<br />Wells Fargo Insurance Services, Inc, - CA Lic#: 0008408
<br />E-MAIL ron.rodriguez wellsfar a.ggm
<br />ACORES$:
<br />333 S. Grand
<br />INSURER(S) AFFORDING COVERAGE MAIC ##
<br />Las Angeles, CA 90071 — --��
<br />_
<br />INSURER A: Philadelphia Indemnity Insurance Company 18058
<br />INSURED
<br />INSURER a: Empioyer5 Assurance Company
<br />--
<br />25402
<br />Discovery Sclence Center of Orange County
<br />��
<br />INSURER C
<br />dba Discovery Cube Orange County
<br />INSURER D:
<br />2500 N. Main Street
<br />INSURER E :
<br />Santa Ana, CA 92705
<br />INSURER F ; ---
<br />--
<br />COVERAGES CERTIFICATE NUMBER: 11200600 REVISION NUMBER: See below
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L18TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS,
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />A
<br />I
<br />UBR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDIQYYYY
<br />POLICY EXP
<br />MM DDIYYYY
<br />LIMITS
<br />A
<br />j(
<br />COMMERCIAL GENERAL LIABILITY
<br />IX
<br />CLAIMS•MADE CJ OCCUR
<br />PHPIC1590101
<br />12115l2016
<br />711/2018
<br />EACH
<br />5 1,OOp,000
<br />PREMISES (Ea ocxurranre
<br />REMDAMAIS56 EaE�f )rr c
<br />S 1,000,000
<br />�
<br />MED EXP (Any one person)
<br />$ 5,000
<br />_
<br />PERSONAL & ADV INJURY
<br />5 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER!
<br />POLICY �] JEC F I I.00
<br />GENE RAL AGGREGATE
<br />I $ 2,000,000
<br />PRODUCTS •COMPIOPAGG
<br />$ 2,000,000
<br />Sexual AbuselM*Ieetatiun
<br />5 Included
<br />OTHER:
<br />A
<br />AUTOM0131LE
<br />LIABILITY
<br />PHPK15901D1
<br />12/15/2016
<br />711I2018
<br />COMBINED SINGLE LIMIT
<br />Eaac dent
<br />1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODI..__...,...._--Per,,.,. ide
<br />BODILY INJURY (PBr accidenlJ
<br />__.•....
<br />$
<br />X
<br />HIRED X NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE."__
<br />Per aocldent
<br />$
<br />e
<br />$
<br />A
<br />x
<br />UMHRELLALIAB
<br />X
<br />OCCUR
<br />P111.113567098
<br />12/15/2016
<br />7/1/2018
<br />EACHOCCURRENCr _
<br />,.
<br />$ 11,000,000
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />AGGREGATEry
<br />$ 11,000,000
<br />DELI 12ETEN710N
<br />$
<br />I3
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY
<br />ANYPROPRIETORIPARTNERlLXEGUTIUE Y 1 N
<br />RFFICERIMGM6EREXCLUDEn7
<br />(Mandatory In NHI
<br />MIA
<br />EIG1453$13"04
<br />04101/16
<br />D4101117
<br />x PER Ol
<br />STAT TE ER
<br />""'-'
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DtSEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATJON9 below
<br />E.L. D SEASE - POLICY LIMIT
<br />$ 1,000,000
<br />s _
<br />DESCRIPTION OF DPERATIDN5!LOCATIONS 1 VEHICLES (ACORD 401, Additional Remarks sehdule, mayb�alla;
<br />The City of Santa Ana, Parks, Recreatkin and Community Services Agency is includ 'for General Llabllty as required by written
<br />contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana, its officers, agents, and employees
<br />Parks, Recreation and Cnmrnunit Services Agency
<br />Y 9 Y
<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 />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />(�
<br />The ACORD name and logo are registered marks of ACORD Cs 1988.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) 111111111111111111111111111111111111111111111111111111111 1111� 11111111111111111111111
<br />'CYBq 1 A2nlnnn2Tn1021T)W0001n'
<br />
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