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KOSM&AS-01 BSTERNBERG <br />AcoR®` CERTIFICATE OF LIABILITY INSURANCE <br />1I07( <br />D vq <br />0 7111 212 0 21201 1 7 <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 BYTHEPOLICIES <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(les) 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 License # OC36891 <br />Lyddy Martin Company <br />20300 Ventura Blvd. Suite 340 <br />Woodland Hills, CA 91364 <br />CAONTA <br />E:CT Brett R Sternberg <br />PAH)ONN310) 478.2625 317 FAX <br />o, Exi: ( (AIC, No): <br />��'Nb : brett@lyddymartin.com <br />INSURERS AFFORDING COVERAGE NAIC Is <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />INSURERA:Zurich American Insurance Company of Illinois 27855 <br />INSURED <br />INSURER B: Foremost Signature Insurance Company 41513 <br />INSURER C : <br />Kosmont & Associates, Inc. <br />Dba: Kosmont Companies <br />1601 N. Sepulveda Blvd. #382 <br />INSURER D: <br />INSURER E: <br />Manhattan Beach, CA 90266 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 11 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 />TYPE OF INSURANCE <br />ADDLSUBR INSD <br />MD <br />POLICY NUMBER <br />POLICY EFF <br />POLICY EXPJLTIL <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE ® OCCUR <br />X <br />PASO40846504 <br />06127/2017 <br />06/27/2018 <br />EACH OCCURRENCE $ 1'000'000 <br />DAMAGE TO RENTEDPREMISES (Ea Qcc,,,r 1,000,001,000,000 <br />X <br />MED EXP (Any oneperson) 10'000 <br />Contractual Liab <br />cluded <br />PERSONAL &ADV INJURYP2,000,000 <br />AGGREGATE LIMIT APPLIES PER: <br />F7 PEO F7 LOC <br />GENERAL AGGREGATEPOLICY <br />GEN'L <br />PRODUCTS-COMPIOPAGG00,000OTHER:B <br />AUTOMOBILE <br />LIABILITY <br />COMBINEOSINGLE LIMIT00,000EaccidentANYAUTO <br />BODILY INJURY Per erson <br />X <br />PASO40846504 <br />06127/2017 <br />06/27/2018 <br />OWNED SCHEDULEDAUTEOS ONLY ALTOpSW <br />BRODILY INJURYPer accidentXAl)T <br />PPe�accitle,t AMAGE <br />O& ONLY AUTOS ONLY <br />A <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 3,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />X <br />PASO40846504 <br />06/27/2017 <br />0612712018 <br />AGGREGATE $ 3,000,000 <br />DED RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />OFFICERIMEMBER EXCLUDED?ECUTIVE ❑ <br />(Mandatory In NH) <br />NIA <br />PER OTH <br />U E ER <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />Ifyes,desabe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) p <br />The City of Santa Ana, Its officers, employees, agents, volunteers and representatives are named additional insured <br />3�1(r�n}-��--.•-J) <br />Y� <br />�3 <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016103) @ 1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Cit of Santa Ana <br />Y <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Marc Morley <br />20 Civic Center Plaza (M-25) <br />AUTHORIZED REPRESENTATIVE <br />JS1G <br />Santa Ana, DA 92702 <br />ACORD 25 (2016103) @ 1988.2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />