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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDIYYYY)
<br />16- � 8/1/2018
<br />7/17/2017
<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 Lockton Companies
<br />NACT
<br />NAME:
<br />444 W. 47th Street, Suite 900
<br />PHONE FAX
<br />Kansas City MO 64112-1906
<br />A/C No,
<br />o Ext): A/C No7:
<br />E-MAIL
<br />(816)960-9000
<br />ADDRESS:
<br />EACH OCCURRENCE .,_
<br />$ 1 ,000000
<br />_
<br />PREMISES (Ea occurrDAMAGE TO ence) $ 300,)00
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Zurich American Insurance Company
<br />1.6535
<br />INSURED WACHTER, INC.
<br />INSURER B: Great American Insurance CO Of New York
<br />22136
<br />6969 16001 WEST 99TH STREET
<br />INSURER C
<br />_
<br />LENEXA KS 66219
<br />INSURER D
<br />INSURER E:
<br />INSURER F:
<br />AGGREGATE LIMIT APPLIES PER:
<br />_
<br />GENERAL AGGREGATE $ 2,000,000
<br />COVERAGES * CERTIFICATE NUMBER: 1471 1718 REVISION NUMBER: XXXXXXX
<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. SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />(NSR
<br />LTR
<br />T
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />W VD
<br />1LIMITS
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE [A] OCCUR
<br />N
<br />N
<br />GLO55_579805
<br />8/1/_017
<br />8(I/ 018
<br />EACH OCCURRENCE .,_
<br />$ 1 ,000000
<br />_
<br />PREMISES (Ea occurrDAMAGE TO ence) $ 300,)00
<br />_
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />_
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L
<br />POLICY XI JEEl LOC
<br />- -
<br />PRODUCTS -_COMPIOPA_G_G 2,000,000
<br />_$
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />N
<br />N
<br />BAP552579905
<br />8/1/2017
<br />8/1/2018
<br />C O BINEDISINGLE LIMIT $ I-000,000
<br />BODILY INJURY (Per person) $ XXXXXXX
<br />XANY
<br />AUTO
<br />OWNED SCHED
<br />AUTOS ONLY AUTOSULED
<br />BODILY INJURY (Per accident) $ XXXXXXX
<br />X
<br />HIRED
<br />AUTOS ONLY X AUTOS ONLY
<br />PeOr a en cidDAMAGE $ XXXXXXX
<br />Com /Coll Deds. $ 1,000
<br />X PHYS DAM
<br />BUMBRELLA
<br />LIAB
<br />X
<br />OCCUR
<br />N
<br />N
<br />UMB9999693
<br />8/1/2017
<br />8/1/2018
<br />_ EACH OCCURRENCE $-2,000,Q00
<br />AGGREGATE $ 2,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED I RETENTION $
<br />$XXXXXXX
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.
<br />OFFICER/MEMBER EXCLUDED? N
<br />N / A
<br />jq
<br />WCSS258000S
<br />8/L/_OI7
<br />8/L/_018
<br />X STATUTE EORH_
<br />EACH ACCIDENT $ 1,000,000
<br />-
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(,Mandatory in NH)
<br />( describe uner
<br />DESCRIPTION OP OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />FOR CANCELLATION FOR ANY REASON OTHER THAN NONPAYMENT OF PREMIUM, THE INSURER(S) WILL SEND 30 DAYS NOTICE OF
<br />CANCELLATION TO THE CERTIFICATE HOLDER. CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND
<br />REPRESENTATIVES 1SIAPINSUREDS) ON PRIMARY,AND NON-CONTRiBUT-RY COVERAGE BASIS AS RESPECTS LIABILITY
<br />COVERAGE FOR THIS PROJECT. INSURANCE SHOWN APPLIES ONLY TO EXTENT OF WRITTEN CONTRACT.
<br />REVIEWED BY: ��°�'4 EUNICE HEREDIA (PG i OF 1)
<br />V
<br />I,Cri l lr ik m I G r1VLUr-n I..Affl rMLLH I IUN Jee ,ximcnnient
<br />14711718
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA (M-30)
<br />SANTA ANA CA 92702
<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
<br />(c) igRR4"Jn15 Arf)R17 rnAPnPATICIN All rinh+c r...r rl
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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