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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />10/03/2017
<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(les) must have ADDITIONAL INSURED provisions or be endorsed. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />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 />aC No): (800) 363-0105
<br />(aC No.Ext): (866) 283-7122 (AIC.
<br />E-MAIL
<br />ADDRESS:
<br />3565 Piedmont Rd NE,Blg1,#700
<br />Atlanta GA 30305 USA
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />LIMITS
<br />INSURED
<br />INSURERA: Lexington Insurance Company 19437
<br />U. S. Security Associates, Inc.
<br />200 Mansell Court East, 5th Floor
<br />Roswell GA 30076 USA
<br />INSURER IS: Liberty Mutual Fire Ins Co 23035
<br />INSURER C: Liberty insurance Corporation 42404
<br />INSURERD: Lloyd's Syndicate No. 1969 AA1120106
<br />& conditions
<br />INSURER E:
<br />INSURER F:
<br />DAMAGE TO RENTED- $500,000
<br />PREMISES Ea occurrence
<br />GUVtKAUtS ChiliIFIGAIL NUMBER: bfUU(idd3ti1Z4 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 />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />POLICY PROVISIONS.
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />AUTHORIZED REPRESENTATIVE
<br />ILTR
<br />TYPE OF INSURANCE
<br />INSD DL
<br />WVD
<br />POLICY NUMBER
<br />MM/DD/OLICYYYYY
<br />MMIDD/YYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE[ 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 />N
<br />M
<br />PERSONAL& ADV INJURY $2,000,000
<br />GEMLAGGREGATELIMITAPPLIESPER:
<br />POLICY PEO- 7 LOC
<br />GENERAL AGGREGATE $4,000,000
<br />PRODUCTS-COMP/OPAGG included
<br />OTHER:
<br />q
<br />I Professional Liability included
<br />B
<br />AUTOMOBILE LIABILITY
<br />AS2-641-443931-057
<br />08/01/2017
<br />08/01/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident $3,000,000
<br />`O
<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 />ZO
<br />y
<br />b+
<br />N
<br />BODILY INJURY (Per accident)
<br />PROPER'fYDAMAGE
<br />Per accldent
<br />D
<br />X
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />CSUSA1701997
<br />08/01/2017
<br />08/01/2018
<br />.EACH OCCURRENCE $5,000,000
<br />U
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE $5,000,000
<br />DED I X. RETENTION $2 5, 000
<br />C
<br />C
<br />WORKERS TIONAND Y/N
<br />EMPLOYERS' LIABILTY
<br />ANY PROPRI TOR OFFICEMMEMER/ XCLUDED?TNEEXECUTIVE. N
<br />(Mandatory In Nil)
<br />N/A
<br />AOS64D443931017
<br />WC7641443931047
<br />MN & WI
<br />0$/01 2017
<br />08/01/2017
<br />08 /01/2018
<br />08/01/2018
<br />X STATUTE PRH
<br />E,LEACHACCIDENT $1,000,000
<br />E,L. DISEASE -EA EMPLOYEE $1,000,000
<br />-
<br />describe under
<br />If yes, DESCRIPTION OF OPERATIONS below
<br />E,L. DISEASE-POLICY LIMIT $1,000,000
<br />1,000,000il®
<br />Nil
<br />ft�.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 m y e delivered to certificate Holders
<br />in accordance with the policy provisions of each policy.
<br />REVIEWED BY: EUNICE HERF_DIA (PG
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<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />01988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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<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 />01988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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