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ACC >RL>�DATE
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />(MMfDDNYYY)
<br />CERTIFICATE MAY BE ISSUED OR. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />6/26/2017
<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, EXTENDOR 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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the Ipolicy, 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 />CONTACT Fernando Rivas
<br />I'SU Insurance Services - Centinel .Agency, LLC
<br />NAME:
<br />PHHOONEo,Extl, (415)657-2000 CAwoi:(415)657-2002
<br />250 Executive Park Blvd
<br />E-MAIL
<br />ADDRESS: fernando(isuca.com
<br />Suite 4800
<br />............ INSURER45) AFFORDING COVERAGE WAIC fk
<br />San Francisco CA 94134 _
<br />..........
<br />INSURER A:Scottsdale.,_.Insurance Compannnny+,'..,..
<br />INSURED
<br />INSURER B :American Fire and Casualt Com an _.
<br />California Barricade Rentals Inc
<br />INSURER cNational Union. Fire Ins Co of
<br />INSURERD State Compensation Ins. Fund
<br />1550 E Saint Gertrude Place
<br />X
<br />INSURER„E:Hiscox Insurance C9mp_lkr;y, XASC
<br />BCSOD36349
<br />Santa Ana CA 92705
<br />INSURERF:Kins'ale Insurance Company
<br />MED EXP (Any one person)
<br />■!(!1'�17:4�[C17,.: 117.7 � 17 rM�7 �I71 I l' I,r,l _{ 7'iiyOR.itNMR'"Y�Mll.�a'�:+[,'#�F2S�w �!"J X171 C^7 r�1:i� lI �1 �t� I ^_7
<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 ....- .. _..... _ ADQL SUBR .._'_. ...- .-.-...... POLICY EFF POLICY EXP ----_._._,...._........ ,.__—
<br />TYPE OF INSURANCE _..,. .......
<br />LTR POLICY NUMBER MM1QDfY'YYY � MM1DDfYYY'Y LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURR17NCE
<br />$ 1, 000, 000
<br />A
<br />—
<br />. CLAIMS -MADE OCCUR
<br />DAMAGED RENTED
<br />PREMISE .._„„._.,,....., _
<br />occurrence
<br />......-m.,.
<br />$ 100,000
<br />X
<br />BCSOD36349
<br />7/1/2017
<br />7/1/2018
<br />MED EXP (Any one person)
<br />$ Excluded..
<br />PERSONAL &AOV INJURY
<br />$ 1.,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />POLICY,. a JEGT �..... 1 LOC
<br />PRODUCTS • COMPIOP AGG
<br />$ 21000,000
<br />Employee Benefits
<br />'.$ 1,000,000
<br />LX
<br />OTHER:
<br />AUTOMOBILE.
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)_
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />XANY
<br />AUTO
<br />.........
<br />BODILY INJURY (Per accident)
<br />$
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />X
<br />BAA (18) 58 OS 63 03
<br />7/1/2017
<br />7/1/2018
<br />X.
<br />NON-OWNED
<br />X I�!
<br />(UTOSp�rOa
<br />$
<br />HIRED AUTOS A
<br />tlent)AMRGE
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />C.,,..
<br />EXCESS LIAB'
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$ 5.000,000,...
<br />DED RETENTION$
<br />BE 065409561
<br />7/1/201.7
<br />I 7/1/2018
<br />''',
<br />WORKERS COMPENSATION'..
<br />X PER V OTH-
<br />STATUTE ER
<br />AND EMPLOYERS' LIABILITY YIN
<br />.........._
<br />ANY PROPRIETORIPARTNERIEXECUTIVE n
<br />E.L EACH ACCIDENT
<br />$ 1 ,000,000
<br />OFFICERIMEMBEREXCLUDED? l 1...,....
<br />(Mandatory in NH) ...
<br />NIA..
<br />9063608-17
<br />7/1/2017
<br />7/1/201.8
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1, 000,000
<br />If yes, describe under
<br />.......,__.
<br />.....................—
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />E
<br />Professional Liability
<br />MPL1863490,16
<br />12/1./2016
<br />12/1/2017
<br />Each Claim $1,000,000
<br />F
<br />Pollution Liability
<br />0100...052798-0
<br />7/9./2017
<br />7/1/2018
<br />Each Pollution Condition $1,000,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ,,�r[.e
<br />The City of 'Santa Ana, its officers, employees, agents, and representative ed as additi
<br />_
<br />insured per form CG 20 33 04 13 and CG 20 37 04 1.3 on the GL policy.
<br />w °"fir _ o
<br />Additional Insured applies per form CA 88 10 01 13 on the Auto policy.`.°
<br />Those usual to the insured's operations.
<br />Jy'\A\\
<br />t;tK I IrIt;A I t MULUtK GANGELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza - M-23
<br />Santa Ana, CA 92702
<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 />AUTHORIZED REPRESENTATIVE
<br />Josh Ferenc/FR c'.tee�
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2'014101) The ACORD name and logo are registered marks of ACORD
<br />INS025 rarl14M
<br />
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