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A �® CERTIFICATE OF LIABILITY INSURANCE �t12017 <br />71i ol <br />f <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 have ADDITIONAL INSURED provisions or he endorsed. <br />It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemenL A statement an <br />this carfi icate does not Confer rights to the certificate hGlder In lieu of such endorsements . <br />PRODUCER Lockton Companies <br />444 W. 47th Streel, Suite 900 <br />Kansas City MO 64112-1906 <br />(816)960.9000 <br />NAME: <br />PRONE T F <br />EDUa <br />ADDRESS, <br />INSURERS AFFORDING COVERAGE <br />NNCd <br />INsvRERA: arT[b Fire InsuranceConivany <br />19682 <br />INSURED INC. <br />1012100 WREN HILLS <br />8404 tNDI N AN HLS DRIVE <br />OMAHA, NE 681144049 <br />INSURERS: Travelers PropertyCasualty CO DfAmerica <br />25674 <br />INsuasac:American Zurich Insurance Company <br />40542 <br />INSURER O t Lexington Insurance Company <br />19437 <br />NSURERe: <br />INSURER F- <br />cnyizma rPR tirwTMA1 CERTIFICATE NUMBER: 146575173 REVISION NUMBER: XXXXXXX <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW 14AVE 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 WtTH 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 />LM WISH <br />TYPEOFINSURANCE <br />OL <br />9UB8 <br />POLICY NUMBER <br />MMMO S <br />EXP <br />autarvyyrn <br />UNITS <br />A <br />�( <br />COMMERCIAL GENERALIJAMUTY <br />CLAIM&MADE OCCURPREMISESIEnacaponml <br />Y <br />Y <br />37CSE00095D <br />611/2016 <br />6/1/2017 <br />EACH OCCURRENCE <br />f 000000 <br />DAMAGE TO RENTED <br />f 000000 <br />X <br />MEO EXP An one Crean <br />f 10,000 <br />CONTRACTUAL LIAR <br />PERSONAldAOVINAJRY <br />S 1000000 <br />OENt AGOREflATE LDJR APPLIES PER: <br />POUCY� 8GT ❑X LOC <br />GENERALAOGREGATE <br />S 2000000 <br />PRODUCTS-COMPiOPAGO <br />f 2000000 <br />f <br />OTHER; <br />A <br />A <br />A <br />AUTOMOBILELIABILIIY <br />X ANY AUTO <br />N <br />N <br />37CSEppU0951((AOS) <br />77esE0009s2{HI) <br />37CSE U1160 MA) <br />Z112D16 <br />611/2016 <br />6/1/2016 <br />6/112017 <br />6/I/2017 <br />6112017 <br />C MBINaDI SINGLE LIMIT <br />f 2000000 <br />BODILY INJURY (Pat pant) <br />f )CX)(X)O(X <br />BODILY INJURY (Patao7AonG <br />; <br />OWNED AUTOSONLY AUmS SCHEDULED <br />HIRED NEO <br />X AUTOS ONLY X AUTOSWNLY <br />Po eR AA O <br />S XX)U= <br />IXXXXXXX <br />B <br />UMBRELLA UJUB <br />EXCESS LNa <br />X <br />occuR <br />CWNB-MADE <br />N <br />N <br />ZUP-JOR64084.16-NF <br />(EXCLUDES PROF. LIAS) <br />611nOW <br />6/1/2017 <br />EACHOCCURRENCE <br />f 000000 <br />AWREGNIE <br />f 1,000,000 <br />DEO <br />I I RETIRTBONS <br />f <br />C <br />WORNERSCOMPENSATION <br />ANDEMPLOYERB•L0ui1LRY YIN <br />AOPW FXTXtRtE EOT CUTWE <br />wqNaadnayin tat) <br />MIA <br />Y <br />0381127 <br />7/I/2D)6 <br />7/I/2017 <br />ER OTN <br />X TUTE <br />EL.EACHACCIDENT <br />f i 000000 <br />EL DISEASE -EA EMPLO <br />f 000000 <br />E.DISEASE-POUCYUMIT <br />f 10 0000 <br />OEs'd4P, iON0FOPERATIONSOe3pw <br />D <br />ARCHS&ENDS <br />PROFESSIONAL <br />IN <br />061853691 <br />6/112016 <br />6/1/2017 <br />PER CLAIM: $1,000,000. AGG: <br />$2,000,000. <br />LIABILITY <br />DESCRIPTIONGFOPERATIONSILOCAnONSIVEHICLES (ACORD 101, AddlllPnnl Romadm Bchodulp. may bo elinghpd l/mom apace le requlretl) <br />CITY OF SANTA ANA -ON CALL RIGHT OF WAY COORD[NATOR (RFP 16-141). CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, <br />VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL INSURED ON GENERAL LIABiLrTY AS PER WRITTEN CONTRACT, ON A <br />PRIMARY, NON-CONTRIBUTORY BASIS. WAIVER OF SUBROGATION APPLIES WHERE ALLOWABLE BY LAW. 30 DAYS NOTICE OF <br />CANCELLATION APPLIES, 10 DAYS NOTICE FOR NON-PAYMENT OF PREMIUM. <br />... - _. <br />REVIEWED BY: _ „ EUNICE HEREDIA,(PG <br />14657873 <br />CITY OF SANTA ANA <br />A7r1N: MARIA D. HUIZAR <br />20 CIVIC CENTER PLAZA (M-30) <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <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 />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />