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ArCC>Fi"d CERTIFICATE OF LIABILITY INSURANCE <br />'i <br />DAT ) <br />Accik�, 1171322 <br />7 7/13/2/13/201177 <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(les) 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 CONTACT gg8-82II-9365 <br />NAME:PHONE <br />Lockton Companies, LLC FAX <br />5847 San Felipe, Suite 320 A C N <br />EMAIL <br />Houston, TX 77057 ADDRESS: <br />INSURERS AFFORDING COVERAGE NAIC N <br />INSURER A: Ace American Insurance Co. 22667 <br />INSURED INSURER B: <br />Insperily, Inc. LICIF <br />KOSMONT & ASSOCIATES, INC. INSURER C : <br />19001 Crescent Springs Drive <br />Kingwood, TX 77339 INSURER D <br />INSU REft E: <br />INSURER F: <br />COVERAGES 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 BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />1=SUD <br />POLICYNUMBER <br />POLICY EFF <br />MMIDOVVYV <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ <br />F7 <br />DAMAGE TO RENTED <br />CLAIMS -MADE OCCUR <br />PREMISES Eacccurrence $ <br />MED EXP(Any one person) $ <br />PERSONAL& ADV INJURY $ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ <br />POLICY ❑ JECCT LOC <br />PRODUCTS COMP/DPAGG $ <br />$ <br />OTHER: <br />1 <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ <br />Ea accident) <br />BODILY INJURY (Par person) $ <br />ANYAUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) $ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />PROPERTY DAMAGE $ <br />Per accident <br />UMBRELLA LIAB <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />$ <br />WORKERS COMPENSATION <br />ANDEMPLOYERS' LIABILITY Y/N <br />X PER OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />A <br />ANY OFFICER/MEMBER EXCLUDED? F-1 <br />❑NIA <br />049287549 <br />10/1/2016 <br />10/1/2017 <br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000 <br />(Mandatory in NH) <br />If yes, describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT $ 1,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ) <br />V <br />1 UV <br />CITY OF SANTA ANA <br />ATTN: MARC MORLEY <br />20 CIVIC CENTER PLAZA (M-25) <br />SANTA ANA, CA 92702 <br />ACORD 25 (2014/01) The ACORD name and logo are registered <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED <br />IN ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />