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ACC> /0- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
<br />12/11/2017
<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 pollcy(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 CONTACT Tina Cowie
<br />NAME:
<br />Cornerstone Specialty Insurance Services, Inc. PHONE (714)731-7700 FAX (714)731-7750
<br />A/C No Ext : A/C, No :
<br />14252 Culver Drive, A299 E-MAIL tina@cornerstonespecialty.com
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />Irvine
<br />INSURED
<br />CA 92604
<br />C BELOW, INC. IN$UI
<br />14280 Euclid Avenue INSU
<br />INSU'
<br />Chino CA 91710 INSUi
<br />COVERAGES CERTIFICATE NUMBER! 17/18 CERTIFICATI
<br />Travelers Property Casualty Co
<br />Travelers Indemnity Co of Conn
<br />Continental Casualty Company
<br />REVISION NUMBFRt
<br />20443
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />GE RTIFICATE:MAY:I315 ISSUED OR MAY=PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />-.
<br />=1 EXCLUSIQR8 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE, BEEN REDUCED BY PAID CLAIMS,INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />N
<br />POLICY NUMBER -
<br />MM D Y
<br />M ID/Y
<br />LIMITS - -
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />1X
<br />EACH OCOURRENCE
<br />2,000'000
<br />TO
<br />PR- 1 S Eao trrence)
<br />$ 100,0
<br />MRR EXP (Any one person)
<br />$w600
<br />ADDTL INSURED
<br />X
<br />BLNKT WVR OF SUBRO
<br />p,RSONAL&ADv INJURY
<br />$ 2,OD0,000
<br />A
<br />Y
<br />Y
<br />680-SH569891
<br />12/18/2017
<br />12/18/2018
<br />GEN'LAGGREGATE LIMITAPPLIE$ PSf Ss
<br />POLICY LA PRO LOG_
<br />dEN RAL'AQGREGAT -
<br />$ 4 000,QOO
<br />PRODUCTS �cOMP/OPAGp
<br />$ 4,000,000
<br />Employee Benefits
<br />$ 2,000,000
<br />0'THE: R; - ,
<br />= - .
<br />AUTOMOBILE
<br />LIABILITY _
<br />_
<br />aac N n SING E 'I T -
<br />$ 1,000,000 .
<br />X
<br />BODILY INJURY (Par person)
<br />$
<br />ANYAUTo
<br />B
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />Y
<br />Y
<br />BA-7D687122
<br />12/18/2017
<br />12/18/2018
<br />BODILY INJURY (Per accident)
<br />$
<br />P O E YDA A E
<br />$
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000.000
<br />AGGREGATE
<br />$
<br />A
<br />EXCESS LIAB
<br />CLAI S M DE
<br />Y
<br />Y
<br />CUP•4181TO34
<br />12/18/2017
<br />12/18/2018
<br />X
<br />DED I I RETENTION $ 0
<br />$
<br />-
<br />A
<br />WORKERS COMPENSATION_.
<br />AND EMPLOYERS' LIABILITY
<br />ANY CERIMEMB R/PARTNEERXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED? t_-_J
<br />(Mandatory in NH) 1
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />Y
<br />XJUB-4181T277
<br />12/18/2017
<br />12/18/2018
<br />X P A U
<br />E'L'EACHACCIDENT-��
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DISEASE -POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liability
<br />Claims Made
<br />MCH288306745
<br />12/18/2017
<br />12/18/2018
<br />Each Claim
<br />$2,000,000
<br />Annual Aggregate
<br />$2,000,000
<br />DESCRIPTION OF OPERATIONS / 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 for General Liability but only if
<br />required by written contract with the Named insured prior to an occurrence and as per attached endorsement. Coverage is subject to all
<br />policy terms and conditions.'30 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 claims reported within the policy period.
<br />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 --
<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 />CA 92702_d� ei4-t
<br />01988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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