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OP ID: DB <br />�•-"'CERTIFICATE OF LIABILITY INSURANCE <br />OATS (M5/2017 <br />Ob10512017 <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(les) 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 <br />yallejo Insurance Associates <br />P.O. Box 4446 <br />Vallejo, CA 94690 <br />Jeanne Kilkenny -Turk <br />CONAME: TACT <br />PHONE FAX <br />ac No E><n•707-654.6080 ac No: 707.654.2188 <br />ADMft as: <br />PftoaucER ,KELLY -2 <br />CUSTOMER ID <br />INSURER ($) AFFORDING COVERAGE <br />NAIL A <br />EACH OCCURRENCE $ <br />INSURED Kelly Associates Management <br />INSURERA:State Compensation Ins. Fund <br />PERSONAL & ADV _INJURY $ _ <br />Group, LLC <br />1440 N. Harbor Blvd. Ste. 900 <br />Fullerton, CA 92838 <br />INSURER B: United States Liability _ <br />- <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- LOC <br />JEGT 1-1AUTOMOBILE <br />INSURER c : <br />$ <br />INSURER D <br />IN8URER E <br />INSURER P <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <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 />ITR <br />TYPE OF INSURANCE <br />DL <br />City of Santa Ana <br />POLICY NUMBER <br />MMIOONYYY <br />MWODIXY <br />LIMITS <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE [.�] OCCUR <br />EACH OCCURRENCE $ <br />ENT 0 <br />PREMISES Ea occurrence $ <br />MED EXP Any one arson) $ <br />PERSONAL & ADV _INJURY $ _ <br />GENERAL AGGREGATE $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO- LOC <br />JEGT 1-1AUTOMOBILE <br />PRODUCTS - COMP/OP AGG $ <br />$ <br />LIABILITY <br />ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />HIRED AUTOS <br />NON-OWNEDAUTOS$ <br />COMBINED SINGLE LIMIT $ <br />(Ea necldenl) <br />BODILY INJURY (Per person) $ <br />BODILY INJURY(Per accident) $ <br />PROPERTY DAMAGE <br />(PERACCIDENT) $ <br />_ $— <br />UMBRELLA LIAR <br />EXCESS LIAR <br />OCCUR <br />CLAIMS -MADE <br />EACH OCCURRENCE $ <br />_ <br />AGGREGATE $ <br />DEDUCTIBLE <br />RETENTION $ <br />$ <br />-_ _- <br />$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNER!EXECUTIVE YIN <br />OFyFICERM In ER <br />(Mandatory In H)EXCLUDED? <br />nd.r <br />OESa6IRIPTION OF OPERATIONS below <br />NIA <br />1969867.2016 <br />09127/2016 <br />09/27/2017 <br />K WC STATU- OTH- <br />` S E <br />E.L. EACH ACCIDENT $ 1,000,090 <br />E.L. DISEASE - EA EMPLOYEE $ 1,009,000 <br />E.L. DISEASEe -POLICY LIMIT $ 1,009000 <br />B <br />Professional Liab <br />SP1022772E <br />09/1912016 <br />09/19/2017 <br />LIMIT 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (Attach ACORD 101, Additional Remarks Schodst%If more space Is mqulrod) <br />Evidence of Insurance,(Management Review of City's Reserve Funds) <br />ncoTICIrt ATC Nrl1 nCDO CANCELLATION <br />11 !OO 1988.2009 ACORD GORPORAPQN. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Clerk of The City Council <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />City of Santa Ana <br />20 Civic Center Plaza (M-30) <br />PO Box 1988 <br />Santa Ana, CA 92702-1988 <br />AUTHORIZED REPRESENTATIVE <br />Jeanne Kilkenny -Turk <br />w f „ j <br />11 !OO 1988.2009 ACORD GORPORAPQN. All rights reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />