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OP ID: YC
<br />'4i,'�`� CERTIFICATE OF LIABILITY INSURANCE[UATE06/28/DDYYYY)
<br />06/28/2017
<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 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 />Narver Insurance
<br />641 W. Las Tunas Drive
<br />CONTACT
<br />NAME: June Samarin
<br />�A/HONN , Ext): 626-943-2237 (A/C No); 626-299-1010
<br />PO Box 1509
<br />San Gabriel, CA 91778-1509
<br />WESLEY HAMPTON HOUSE
<br />_
<br />E-MAIL
<br />ADDRESS: JSamarin@narver.com
<br />PRODUCER BULLO-4
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE NA_I_C #
<br />INSURED BA INC.
<br />INSURER A: Travelers Indemnity Company
<br />25682
<br />800 West 6th Street, Suite 400
<br />Los Angeles, CA 90017
<br />INSURER B: State Compensation Ins. Fund
<br />35076
<br />INSURER C: Lloyds of London
<br />15792
<br />INSURER D :
<br />06/21/2017
<br />06/21/2018
<br />INSURER E.'
<br />$ 300,000
<br />INSURER F:
<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 />IPOLICY
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />EFF
<br />MM DD/YYYY
<br />POLICY -EXP _F_
<br />MMIDDYYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />X
<br />680-6J028194
<br />06/21/2017
<br />06/21/2018
<br />DAMAGE(RENTED
<br />PREMISESS Ea occurrence)
<br />$ 300,000
<br />CLAIMS -MADE X OCCUR
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X Contractual
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />Liability
<br />GENERAL AGGREGATE
<br />$ 4,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 4,000,000
<br />POLICY X PRO jECT [7 LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />A
<br />X
<br />ANY AUTO
<br />BA -3C984479
<br />06/21/2017
<br />06/21/2018
<br />(Ea accident)
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />-
<br />BODILY INJURY (Per accident)
<br />------
<br />$
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />A
<br />X
<br />HIRED AUTOS
<br />BA -3C984479
<br />06/21/2017
<br />06/21/2018
<br />(PER ACCIDENT)
<br />$
<br />A
<br />X
<br />NON-OWNEDAUTOS
<br />BA -3C984479
<br />06/21/2017
<br />06/21/2018
<br />$
<br />$
<br />X
<br />UMBRELLA LIAB X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 9,000,000
<br />AGGREGATE
<br />$ 9,000,000
<br />A
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />CUP -5D991542
<br />06/21/2017
<br />06/21/2018
<br />DEDUCTIBLE
<br />$
<br />$
<br />RETENTION $
<br />WORKERS COMPENSATION
<br />X WC SLAT T- OEH-
<br />AND EMPLOYERS' LIABILITY Y/"
<br />E. L. EACH ACCIDENT
<br />$ 1,000,000
<br />B
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />9212148
<br />06/09/2017
<br />11/26/2017
<br />OFFICER/MEMBER EXCLUDED? �
<br />(Mandatory in NH)
<br />N / A
<br />.__...._._._ ...................... ..--- ----------- --__--
<br />E.L. DISEASE - EA EMPLOYEE
<br />--
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liab.
<br />ANE143717317
<br />06/20/2017
<br />06/20/2018
<br />Ea.Claim 2,000,000
<br />Aggregate 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />RE: Contract #A-2017-080
<br />The City of Santa Ana, its officers, employees aggents and representatives
<br />and
<br />are named as additional insured as respects Liability
<br />attached
<br />endorsement CG D3 81, as required by contract. This insurance is primary
<br />and any insurance carried by additional insured shall be non-contributory.
<br />CERTIFICATE HOLDER CANCELLATION
<br />CITYSAN
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />@ 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD,,,
<br />REVIEWED BY; EUNICE HEREDIA (PG I OFq)
<br />
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