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ACORU®
<br />�, .. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIODNYYY)
<br />5/9/2017
<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 />Cornerstone Specialty Insurance Services, Inc.
<br />14252 Culver Drive, A299
<br />Irvine CA 92604
<br />CONT T Tina Cowie
<br />PHONE (714)731-7700 F (714)731-7750
<br />JAIC, No
<br />OOAIL ,tine@cornerstonespeaialty.00m
<br />INSURERS AFFORDING COVERAGE
<br />NAIC It
<br />INSURERA:Travelers Indemnity Cc of Conn
<br />25682
<br />INSURED
<br />C BELOW, INC,
<br />14280 Euclid Avenue
<br />Chino CA 91710
<br />INSURERS:Travelere Property Casualty CO
<br />25674
<br />INSURER C Continental Casualty Company
<br />20443
<br />INSURERD:
<br />INSURER E I
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:16/17 COVERAGES 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 PAIDCLAIMS.
<br />INSR
<br />LT
<br />OF INSURANCE
<br />ADOTYPE
<br />INSM
<br />wvn SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />��
<br />MM/DDIYYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 2, 000, 000
<br />A
<br />CLAIMS -MADE X OCCUR
<br />DAM ISESG RE
<br />occurrence) ce
<br />$ 300,000
<br />X
<br />MED EXP (Any one person)
<br />�
<br />$ 5,000
<br />ADDTL INSURED
<br />680-5059891
<br />12/18/2016
<br />12/18/2017
<br />X
<br />BLNKT WVR OF SUBRO
<br />PERSONAL & ADV INJURY
<br />$ 2,000,000
<br />Per Form #CG03810907
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />As Required by Written
<br />POLICY II JE� LOC
<br />Contract
<br />PRODUCTS • COMPIOPAGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />Contractual Liab included
<br />AUTOMOBILE LIABILITY
<br />C,0MBINE1,1,)SINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />X ANY AUTO
<br />ALLOWNED SCHEDULED
<br />AUTOS AUTOS
<br />&A-7D687122
<br />12/18/2016
<br />12/18/2017
<br />BODILY INJURY (Per accident)
<br />$
<br />X WIRED AUTOS X NON -OWNED
<br />PAUTOSPReOBERTnDAMAGE
<br />$
<br />Undarineured motorist
<br />$ 1,000,000
<br />X
<br />UMBRELLA LIAB
<br />x
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,000
<br />13
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />x
<br />DED I I RETENTION$ 10,000
<br />$
<br />CUP-4181T634
<br />12/18/2016
<br />12/18/2017
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNERIEXECUTIVE Y�
<br />Mandato�nNH EXCLUDED?
<br />(Mandatory )
<br />N / A
<br />XJUB-41SIT277
<br />12/18/2016
<br />12/18/2017
<br />X OTH•
<br />STATUTE
<br />E.L. EACH ACCIDENT
<br />_
<br />$ 1,000,000
<br />E.L. DISEASE • EA EMPLOYE
<br />$ l 000 000
<br />If yes, descrihe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE •POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liability
<br />MCH288306745
<br />12/18/2016
<br />12/18/2017
<br />Each Claim $2,000,000
<br />Claims Made
<br />Annual Aggregate $2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured
<br />for General Liability but only if required by written contract with the Named Insured prior to an
<br />occurrence and as per attached endorsement. Coverage is subject to all policy terms and conditions, *30
<br />days notice of cancellation, except for 10 days notice for non-payment of premium. For Professional
<br />Liability, the aggregate limit is the total insurance for all covered claim reported within the policy
<br />period. REVIEWED BY: � " EUNiCE HEREDIA (PG OF )
<br />City of Santa Ana
<br />20 Civic Center Plaza M-30
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />gg671LR
<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 REPRESENTATIVE
<br />ina Cowie/SGL
<br />Cc0710:141:7_11111Ito] 2 = .T- • M
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 0m4mt
<br />
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