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AC7 J?br CERTIFICATE OF LIABILITY INSURANCE
<br />MMroD1YYYY>DATE (
<br />DATE
<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 SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS.
<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)y AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the potiicy(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 does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />NQMTEACT Jonathan Thomas..
<br />CIBC Insurance Services LLC
<br />PHONE FAx
<br />. 415-946-7500 ar t° 415-946-7550
<br />License #01<1 9767
<br />� C}Id Slip A-2017-039
<br />„_ __ _ ._ ._I
<br />E-MAIL s.. onathan.thomas c stalco.com
<br />.�' ' � �'
<br />INSURERS AFFORDING COVERAGE NAIL #
<br />New York NY 10005
<br />INSURER A:..National Fire Insurance Company of 20478
<br />( $1,000,000
<br />INSURED TTHCLD
<br />INSURER B:Valley Fore Insurance Company 20508
<br />Palermo TT Holdings, Inc.
<br />INSURER C :Continental Casualty Company 20443 _
<br />9477 Waples, Suite 100
<br />INSURER D: Indian Harbor Insurance Company 36940
<br />San Diego, CA 92121
<br />DAMAGE TO RENTED
<br />PREMISES tEa occurrence
<br />i $1,000,000
<br />INSURER E:
<br />$15•',000
<br />INSURER F:
<br />('nVFRA(,'F:R rF:RTIFIC:ATF NU1MRFR. 2005360351
<br />RFVII;InN NIIMRFR-
<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 SHOWNMAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />!MVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDOIYYYY
<br />POLICY EXP
<br />MM�IDDIYYYY
<br />LIMITS
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />6024533045
<br />51112017
<br />51112018
<br />EACH OCCURRENCE
<br />( $1,000,000
<br />CLAIMS -MADE OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES tEa occurrence
<br />i $1,000,000
<br />MED EXP (Any one person)
<br />$15•',000
<br />_ - .... ...-_.mmm_.__......................m...._........._._.._._
<br />PERSONAL B, ADV INJURY
<br />$1,000,000
<br />GENERAL. AGGREGATE
<br />__.._-..
<br />'.... $2,000,000
<br />GENT AGGREGATE LIMIT APPLIES PER:
<br />��-��-��
<br />POLICY r] PRO- x I. LOC
<br />JECT
<br />___..______
<br />PRODUCTS - COMP'IOPAGG
<br />'... $2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />UTABILITXMBINED
<br />6024533059
<br />51112017
<br />5/112018
<br />SINGLE LIMIT
<br />(acciden _
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />X
<br />ANY AUTO
<br />X
<br />OWNED X SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />X
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />fPer accident)
<br />$
<br />A
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />6024533093
<br />51112017
<br />1 511/2018
<br />EACH OCCURRENCE
<br />$10,000,000
<br />AGGREGATE
<br />$10,000,000
<br />EXCESS UAB
<br />CLAIMS -MADE'
<br />DED RETENTION $
<br />$
<br />C
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITYYIN
<br />ANY PROPRIETOR)PARTNERlEXECUU, —LlE.L.
<br />6024533062
<br />6024533076
<br />511/2017
<br />51112017
<br />5/112018
<br />51112,01 S
<br />X PER pTH-
<br />STATUTE ER
<br />EACH ACODENT
<br />_..
<br />$1,000,000
<br />OFFICER/MEMBER EXCLUDED?
<br />N I A
<br />E.L. DISEASE - EA EMPLOYE
<br />$1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERAT6ONS below
<br />E.L. DBSEASE - POLICY LIMIT
<br />1 $1,000,000
<br />D
<br />Tech Professional Liab
<br />MTP903220002
<br />51112017
<br />5/112018
<br />5,000,000 Each Ciaim/occ.
<br />Retroactive Date 1/1/92
<br />5,000,000 Aggregate
<br />Claims Made
<br />100,000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana its officers, employees, agents, volunteers and representatives are included as Additional Insured as required by
<br />written contract, but limited to the operations of the Insured under said contract, per the applicable endorsement with respect to the General
<br />Liability and Automobile Liability policies.
<br />d.�.
<br />LK I II-IL;A It htULLtt,l{
<br />The City of Santa Ana
<br />60 Civic Center Plaza
<br />Santa Ana, CA 92761-0000
<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 />C'.
<br />B
<br />�,.e�
<br />@ 1985-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016163) The ACORD name and logo are registered marks of ACORD
<br />
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