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ACORa CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDDIYVYY)
<br />`,./
<br />1 05/03/2016
<br />THIS CERTIFICATE IS ISSUED ASA 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 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(tes) 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 />CONTACT Nancy Stottlemyer
<br />NAME:
<br />Insurance Brokers of MD- Hagerstown
<br />PHONE (301)790-0652 FAX (301)790-0962
<br />AIC No Ext: AIC, No:
<br />13126 Pennsylvania Ave.
<br />EMAIL nancy.stottlemyer@ibmofmd.Com
<br />ADDRESS:
<br />PO BOX 3767
<br />PREMISES Ea occurrence $ 1.000,000
<br />MED EXP(A,ry one person) $ 10,000
<br />INSURER(S) AFFORDING COVERAGE NAICp
<br />Hagerstown MD 21742
<br />INSURERA: Atlantic Specialty Ins. CO 27154
<br />INSUREDn—,,) I J59
<br />INSURER B:
<br />The Library Corporation ` I
<br />T"'T
<br />INSURER C:
<br />Carl Corporation and Tech -Logic Corporation
<br />INSURER D:
<br />1 Research Park
<br />INSURER E
<br />Inwood WV 25428
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 2016-2019 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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADUL
<br />INSD
<br />SUBR
<br />WD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDD/CCYi`
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CIAIMS-MADE ® OCCUR
<br />EACH OCCURRENCE $ 1,000,000
<br />PREMISES Ea occurrence $ 1.000,000
<br />MED EXP(A,ry one person) $ 10,000
<br />PERSONAL B ADV INJURY $ 1,000,000
<br />A
<br />Y
<br />711015864-0001
<br />05/08/2018
<br />05/08/2019
<br />GEN'LAGGREGATE LIMITAPPLIES PER-.
<br />POLICY [X JECOT F__] LOC
<br />GENERALAGGREGATE E 2,000,000
<br />PRODUCTS - COMPIOPAGG $ 2,000,000
<br />OTHER-
<br />Employee Benefits $ 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea acatlent
<br />BODILY INJURY (Per person) $
<br />ANYAUTO
<br />AOWNED
<br />SCHEDULED
<br />AUTOS ONLY AUTOS
<br />711015864-0001
<br />05/08/2018
<br />05/08/2019
<br />BODILY INJURY (Per saiden0 $
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE
<br />Per accident) $
<br />UM BRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE $ 6,000,000
<br />A
<br />I EXCESS LIAB
<br />CLAIMS -MADE
<br />711015864-0001
<br />05/08/2018
<br />05/08/2019
<br />AGGREGATE g 6,000,000
<br />DED I X RETENTION $ 0
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE N]
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />If yes, tlascribe under
<br />DESCRIPTION OF OPERATIONS Ins.
<br />NIA
<br />406044542-0001
<br />05/08/2018
<br />05/08/2019
<br />X PER OTH-
<br />BTATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1.000,000
<br />E.L DISEASE - POLICY LIMIT $ 1,000,000
<br />A
<br />E&0, Information Risk &Communication
<br />Liability
<br />L
<br />760010008 -0001 -Claims -Made
<br />05/06/2018
<br />05/08/2019
<br />Combined Liability Limit $5,000,000
<br />Max Policy Aggregate $5,000,000
<br />1
<br />Retention $25,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, A4dilicim Remarks Schedule, may be attached if more space is requited)
<br />City of Santa Ana, It's Officers, employees, agents, volunteers and representatives are additional insured as indicated, and Coverage is
<br />primary, non-contributory when required by written Contract per attached form VCG207 (11/13) ea
<br />e��`�
<br />SHOULD ANY OF THE ABOVE DESCRIWPOLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza M-30
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701 7 Fr/'I
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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