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,�t> R" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDt"YYYY)
<br />5/16/201.7
<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 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 CONTACT
<br />CT Brooke Steiner
<br />Charlson-Wilson Insurance PAHrONNa, ext)s (785) 537-1600 1 (AX No): (785)537 1657
<br />555 Poyntz Avenue, Suite 205 ADDR1ESS-bsteiner@charlsonwilson.com
<br />P.O. Box 198:9 ....I'.NSURER(S)"AFFORDING COVERAGE -_ NAIC #
<br />Manhattan KS 66505-1989 PA INSURER A !Chv.bb Group,cif Ins. Companies _.
<br />-.INSURED
<br />CivicPlus, Inc. �. .-.., ..hr INSURER
<br />302 S. 4:th Street, Suite 500 INSURERD:
<br />limanhattan KS 66502 1INSURER F:
<br />i1nk1rI*A1_9Q 1-r-PTIFIr'ATF All IMRI"r7• C117-201A. RFVICION NI IMRFR-
<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 />-1NSR' -__-. -_-- ---- -ADDL SUBR -._ ....... POLICY EFF _ POLICY EXP ' -- -_--LIMITS
<br />LTR TYPE OF INSURANCE POLICY NUMBER MG,AlDDIYYYY MMIDD)YYYY
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 2,000,000
<br />_.
<br />"
<br />A :. CLAIMS -MADE 1i OCCUR
<br />--
<br />DAMAGE TO RENTED $ 2,000,000
<br />PREMISES (Ea occurrence)
<br />x --. blanket contractual
<br />3602-53-12 5/17/2017 5/17/2018 MED EXP (Ary one person) $ 10,000
<br />liability
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERAL AGGREGATE 1 $ 2, 000,000
<br />GENERAL
<br />PRO -
<br />X POLICY LOC
<br />_._. --
<br />PRODUCT, - GOMPIOP AGG $ --. 2,000,000
<br />_ JECT
<br />OTHER:
<br />..
<br />..-
<br />t Information & Network Tach 1 I $ 3,000,000
<br />AUTOMOBILE LIABILITY
<br />f
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />L(Ea acc,dent) ........ . .... -. --_- ___--
<br />X 1 j
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />..� ALL OWNED SCHEDULED
<br />(16) 7358-87-92 5/17/2017 "- 5/17/2018
<br />BODILY INJURY (Per accidank)I $
<br />AUTOS AUTOS
<br />NON
<br />HIRED AUTOS
<br />j
<br />,.. ----
<br />$
<br />_........ ...._. AUTOSWNED
<br />IP ,(Ora cdentjAMAGE
<br />Terrorism �$
<br />UMBRELLA LIAB OCCUR
<br />1
<br />EACH OCCURRENCE $ 5,000,00.0.
<br />A EXCESS LIAR i CLAIMS -MADE]
<br />AGGREGATE $ .
<br />�DED RETENTION$
<br />i7989-49-14 i 5/17/2017 5/17/2018
<br />$
<br />WORKERS COMPENSATION
<br />-
<br />X I STATUTE ORH
<br />AND EMPLOYERS" LIABILITY YINI
<br />I
<br />--
<br />El EACH ACCIDENT $ 1 000, 000
<br />ANY PROPRIETOR/PARTNERIEXFCUTIVE
<br />CFFICERIMEMBER EXCLUDED?
<br />A (Mandatory in NH)
<br />N ! A
<br />(17)7174-92-49 :.: 5/17/2017 5/17/2018
<br />_ _ ,
<br />-
<br />EL DISEASE - EA EMPLOYEE $ --. 1,000,0100....
<br />-- ----- -- --.
<br />If yyes describe under.
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT � $ 1,000,000
<br />A Directors & Officers
<br />8242-9361 5/17/2017 5/17/2018
<br />Aggregate Limit $1,000,000
<br />',. Cyber Liability
<br />3602-53-12 ''! 5/17/2017 5/17/2018
<br />I! I
<br />Aggregate Limit $3, 000, 000
<br />DESCRIPTION OF OPERATIONS) LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached, if more space is required)
<br />eviewed b .
<br />City of Santa .A.na.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />L917fW111.-#.R Wowl1.-l\.I
<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 />make SiLeiner./TAL ` ti
<br />C 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 r7nlantl
<br />
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