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21174
<br />AC40R"a CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM2DDIYYYY)
<br />5/2/2017
<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 INSUREII AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 endorsements .
<br />PRODUCER
<br />Wells Fargo Insurance Services USA, Inc.
<br />NON ACT Wells Fargo Certificate Service Center
<br />PHONE 1-877-932-7475 FAX 1-877-362 9069
<br />PJC No Ext : A,C Na
<br />(Servicing Broker for Wells Fargo &Company)
<br />3475 Piedmont Road NE, Suite 800
<br />ADDRESS: wfis.certificaterequest@wellsfargo.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC#
<br />Atlanta, GA 30305-2886
<br />INSURERA: Old Republic Insurance Company
<br />24147
<br />INSURED
<br />Wells Fargo & Company and its Subsidiaries including
<br />INSURER B:
<br />INSURER C;
<br />Wells Fargo Bank, N.A.
<br />INSURER D:
<br />550 South 4th Street
<br />INSURER E:
<br />Minneapolis, MN 55415
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 11745155 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 />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE[) 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADUL
<br />SUaR
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDD1YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � CCCUR
<br />X
<br />MWZY 304056
<br />04/01/2015
<br />04/01/2020
<br />EACH OCCURRENCE S 10,000,000
<br />DAMAGE(Eaa ED occurrence 10,000,000
<br />PREMISES $
<br />MED EXP (Any one person) $
<br />PERSONAL & ADV INJURY $ 10,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 10,000,000
<br />GEN'L
<br />X
<br />POLICY PRO- ❑ LOC
<br />)ECT
<br />PRODUCTS - COMPIOP AGG $ 10,000,000
<br />S
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />MWTB 304054
<br />04/01/2015
<br />04/01/2020
<br />Ea a¢cdeDtsINGLE LIMIT $ 10,000,000
<br />BODILY INJURY (Por person) $
<br />X
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident) S
<br />X
<br />HIREDX NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE $
<br />Per accident
<br />$
<br />UMBRELLALIAIi
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION$
<br />$
<br />A
<br />WORKERS COMPENSATION410[12015
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERIMEMBEREXCLUDED? N
<br />(Mandatory in NH)
<br />NIA
<br />MWC302638
<br />• `�®�
<br />a N
<br />4�¢d
<br />\�
<br />04/01/2020
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />�f ,I
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS r LOCATIONS 1 VEHICLES (ACORD 101, Additional Re s Sc u .1 attached if more space is required}
<br />Wells Fargo participation in event May 6th -7th, 2017 004,
<br />The City of Santa Ana, , 20 Civic Center Plaza, Santa Ana, California 92702; its officers, agents, employees and volunteers are Additional Insured on
<br />General Liability as respects liability arising out of Named Insured's participation in referenced event per the attached Additional Insured endorsement as
<br />required by contract as required per written contract, subject to policy terms, conditions, and exclusions.
<br />*Such coverage is Primary & Non-contributory
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attention: PRCSA
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />q
<br />The ACORD name and logo are registered marks of ACORD O 1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103)
<br />(Thls cadificate rep1---,0ftA 9 117435B2 1—d an 01212917)
<br />
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