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<br />,G! CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DD/YYYY)
<br />11/13/2017
<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 LICENSE NO. 0637431
<br />NAME: PATRICK MCRAE
<br />PATRICK MCRAE INSURANCE SERVICES
<br />1265 N. MANASSERO ST. SUITE 303
<br />fAAC No. Ext : (714) 779-6999 FAX No): (714) 779-6903
<br />E-MAIL SS: p.mcrae@sbcglobal.net
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />ANAHEIM HILLS, CA92807
<br />INSURERA: COLONY INSURANCE COMPANY
<br />39993
<br />INSURED
<br />INSURERB: INSURANCE COMPANY OF THE WEST
<br />27847
<br />INSURERC: NATIONAL GENERAL INSURANCE
<br />23728
<br />CROSSTOWN ELECTRICAL & DATA, INC.
<br />INSURERD: TOPA INSURANCE COMPANY
<br />18034
<br />5454 DIAZ STREET
<br />INSURERE: TOKIO MARINE SPECIALTY INSURANCE CO
<br />23850
<br />IRWINDALE CA 91706
<br />INSURERF:
<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 />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />SWVD UER
<br />POLICY NUMBER
<br />MM DD/POLICYYYYY
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE AI OCCUR
<br />XCU
<br />X
<br />X
<br />103 GL 0014267-01
<br />DEDUCTIBLE $5,000 PER
<br />OCCURENCE
<br />06/03/2017
<br />06/03/2018
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />RENTED
<br />PREMSES A AGE ToE.occuence
<br />$ 100,000
<br />X
<br />MED EXP (Any one person)
<br />$ 5,000
<br />X
<br />OCP
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICY �X JEC LOC
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />1�
<br />$
<br />OTHER:
<br />C
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />2005675448-01
<br />11 /05/201711
<br />/05/2018
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$ _
<br />X
<br />ANY AUTO
<br />ALL OWNED X SCHEDULED
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />BODILY INJURY (Per accident)
<br />$ -
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$ "
<br />$
<br />E
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />PUB585602
<br />UNDERLYING LIMITS:
<br />GL; AL; EL POLICIES
<br />06/03/2017
<br />06/03/2018
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />X
<br />AGGREGATE
<br />$ 10,000,000
<br />X
<br />DED RETENTION$ 0
<br />$ -
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y
<br />OFFICER/MEMBER EXCLUDED? Y
<br />(Mandatory in NH)
<br />N!A
<br />x
<br />WVE 5030354-02
<br />06/03/2017
<br />06/03/2018
<br />X I STATUTE ERH
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />D
<br />PROPERTY &
<br />CONTRACTORS
<br />EQUIPMENT
<br />PC 6600421
<br />$1,000 DEDUCTIBLE
<br />COV. INCL. THEFT
<br />04/10/2017
<br />04/10/2018
<br />$t,4,3,wdmgs
<br />$385,780 BPp
<br />$198,968Property off Premises
<br />$300,000 Leased BPP
<br />$300,000Bl/EE
<br />DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES ACORD 101, Additional Remarks Schedule, may be attached If more s ace is required)
<br />THE CITY OF SANTA ANA, ALONG WITH THEIR OFFICERS, OFFICIALS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSURED WITH
<br />RESPECTS TO THE ABOVE MENTIONED POLICIES PER ATTACHED ENDORSEMENT(S). COVERAGE IS PRIMARY & NON-CONTRIBUTORY AS REQUIRED BY
<br />WRITTEN CONTRACT, PER ATTACHED ENDORSEMENT FORMS. WAIVER OF SUBROGATION APPLIES, IF REQUIRED BY WRITTEN CONTRACT.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, A 30 DAY WRITTEN NOTICE WILL BE ISSUED.
<br />RE: Agreement #A-2017-172 —— —
<br />CTWN: 3196 REVIEWED PY: EUNICE CiERELOEA (PG OF 7. )
<br />UtK I I[-IL:A I t HUl_utK
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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