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WESTCOM-16 EBRI'
<br />A�COAO
<br />DATE (MMIDDIYYYY)
<br />CERTIFICATE TE OF LIABILITY INSURANCE f 09I14/2017
<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
<br />an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or
<br />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 />License # 0757776 CONTACT . ...
<br />PRODUCER Jordan Bartleson
<br />HUB International Insurance Services Inc. PHONE FAX
<br />3390 University Ave., Ste 300 (A/C, No, Ext) (AIC, No):
<br />....._...
<br />Riverside, CA 92501 E-MAIL
<br />ADDRESS cal.cpu@hubinternational.com
<br />A-2015-112-03
<br />INSURED
<br />Westbound Communications, Inc.
<br />625 The City Dr., Ste 480
<br />Orange, CA 92868
<br />A
<br />00
<br />37273
<br />INSURER F :
<br />OVERAGESmmmmmmITmmm_mmm_ _ 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 BEENREDUCED BY PAID CLAIMS.
<br />..
<br />RI ADDLISUBR POLICY EFF POLICY EXP
<br />a . TYPE OF INSURANCE I POLICY NUMBER ('�hYMJDDI"M"t YYh LIMITS
<br />t X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ 2'000'000
<br />DAMAGE TO RENTED
<br />CLAIMS -MADE OCCUR X X 72SBAIB4627 0510612017 0510612018 1,000 000
<br />.i ,... PREMISEC tE? p..,'u4Adlrt.'1 .. $ .....
<br />MED EXP (Anyone person) $ 10'000
<br />.._ PERSONAL &,ADV INJURY $ 2 OOO OOO
<br />GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000
<br />X POLICY PRO -. LOC 4,000,000
<br />p� .. .... JECT PRODUCTS -COMP/OP AGQ S
<br />__- ....................
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT000
<br />2, '
<br />EXCESS LIAB CLAIMS MADE
<br />72SBAIB4627
<br />05/06/2017
<br />(Ea acadentl
<br />�„
<br />- .........10.000......
<br />I X
<br />ANY AUTO
<br />72SBAIB4627
<br />0510612017 0510612018 BODILY INJURY JPer person)
<br />$
<br />DED RETENTION$
<br />_ ......
<br />OWNEDSCHEDULED
<br />_ $.............
<br />"-
<br />B WORKERS COMPENSATION
<br />AUTOS ONLY
<br />AUTOS
<br />BQDILY INJURY jeer accident)
<br />$
<br />J
<br />AUTOS ONLY --
<br />AUUTOS ONLY
<br />(Per acc dentDAMAGE
<br />$
<br />A X '.. UMBRELLA LIAB X OCCUR
<br />I_
<br />EACH OCCURRENCE $
<br />2,000,000
<br />EXCESS LIAB CLAIMS MADE
<br />72SBAIB4627
<br />05/06/2017
<br />05/06/2018
<br />2'000'000
<br />- .........10.000......
<br />I X
<br />AGGREGATE $
<br />- —
<br />DED RETENTION$
<br />_ ......
<br />_ $.............
<br />B WORKERS COMPENSATION
<br />PER T
<br />ORH
<br />AND EMPLOYERS'LIABILITY
<br />Y
<br />" XL ST E
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />NIA
<br />72WECLR3783
<br />7
<br />O9I28I2O1
<br />09/28/2018
<br />EACH ACCIDENT $
<br />1,000,000
<br />OFFICERIMEMBEREXCLUDED?
<br />(Mandatory in NH)
<br />N...�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,..�,.,--- ...
<br />1'000'000
<br />If yes, describe under
<br />E.L. DISEASE - EA EMPLOYEE:; $
<br />-----.
<br />1,000 000
<br />DESCRIPTION OF OPERATIONS below
<br />W
<br />.,�.�............ w
<br />LIMIT $
<br />E POLICY I
<br />C 'Pofesslonal Liab
<br />MCN000234351 701
<br />09/25/2017
<br />......... ... ._._E..E.
<br />0912512018 Per Claim
<br />3,000,000
<br />C Retention: $10,000
<br />'MCN000234351701
<br />0912512017
<br />0912512018 Aggregate
<br />3,000,000
<br />DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />Fhe City of Santa Ana, it's officers, employees, agents, volunteers and representatives are Additional Insured in regards to General Liability per form
<br />H12001185 which includes 30 Day Notice of Cancellation. Primary & Non -Contributory wording and Waiver of Subrogation coverages apply to the General
<br />_iability policy when required by written contract per the attached endorsement SS0008 04105 (pgs. 16-17 of 24).
<br />CERTIFICATE HOLDER
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Ci
<br />CiCivic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701 ....... _....... .........�..................m_......... N..
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD i
<br />1412P
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