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�°� �'® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />05/16/2017
<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 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 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 endorsement(s).
<br />PRODUCER
<br />Aon Risk Services South, Inc.
<br />Atlanta GA Office
<br />CONTACT
<br />NAME:
<br />(A/CNNo. Ext): (866) 283-7122 (AI , No.): (800) 363-0105
<br />EMAIL
<br />ADDRESS:
<br />3565 Piedmont Rd NE,Blgl,#700
<br />Atlanta GA 30305 USA
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: Lexington insurance Company 19437
<br />U. S. Security Associates, Inc.
<br />200 Mansell court East, 5th Floor
<br />Roswell GA 30076 USA
<br />INSURER B: Liberty Mutual Fire Ins Co 23035
<br />INSURER C: Liberty insurance corporation 42404
<br />INSURER D: Lloyd's syndicate No. 1969 AA112010G
<br />INSURER E:
<br />INSURER F;
<br />11UVtKAUI=b totKIIPIUAIt NUIVIttSpK: 0/000041001U4 KtVI51UN NUMt3tK:
<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. Limits shown are as requested
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />DD
<br />INSD
<br />5 6
<br />WVD
<br />POLICY NUMBER
<br />FF
<br />MMIDD/YYYY
<br />POLICY E
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE X] OCCUR
<br />SIR applies per policy terns
<br />& conditions
<br />EACH OCCURRENCE $2,000,000
<br />DAMAGE TO RENTED$500,000
<br />PREMISES Ea occurrence
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $2,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $4,000,000
<br />POLICY ❑ PRO-JECT LOC
<br />PRODUCTS - COMP/OP AGG Included
<br />OTHER:
<br />Professional Liability Included
<br />B
<br />AUTOMOBILE LIABILITY
<br />As2-641-443931-056
<br />08/01/2016
<br />08/01/2017
<br />COMBINED SINGLE LIMIT Ea accident $1,000,000
<br />_
<br />BODILY INJURY ( Per person)
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIREDAUTOS NON -OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Per accident
<br />D
<br />X
<br />UMBRELLALIABX
<br />OCCUR
<br />WE1600654
<br />08/01/2016
<br />08/01/20 7
<br />EACH OCCURRENCE $5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $5,0001000
<br />DED I X RETENTION 825,000
<br />C
<br />C
<br />WORKE
<br />EMPLOYECOMPENSATION NATION AND BILITY YIN
<br />ANY PROPRIETOR / PARTNER / EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED? rq
<br />(Mandatory In NH)
<br />N/A
<br />A0564D443931016
<br />WC7641443931046
<br />MN & WI
<br />0870-172016
<br />08/01/2016
<br />-68/01/2017
<br />08/01/2017.
<br />X STATUTE
<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 />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />A
<br />Excess Auto Lia
<br />048409879
<br />08/01/2016
<br />08/01/2017
<br />Each occurrence $4,000,000
<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 in
<br />accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary
<br />and Non-contributory to other insurance available to an Additional Insured, but only in accordance with the policy's
<br />provisions. should General Liability, Automobile Liability and Workers' Compensation policies be cancelled before the
<br />expiration date thereof, the policy provisions will govern how Notice of cancellation in a delivered to Certificate Holders
<br />in accordance with the policy provisions.
<br />REVIEWED BY: EUNICE HER DIA (PG OF l )
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />The city Of Santa Ana
<br />20 civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701 USA
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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