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ACi' CERTIFICATE OF LIABILITY INSURANCE
<br />GATE YYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />031311/20172017
<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 endorsements .
<br />PRODUCER
<br />CONTACT
<br />NAME:
<br />Marsh Risk ix Insurance Services
<br />PHONE FAX
<br />17901 Von Karman Avenue, Suite 1100
<br />No:
<br />EMAIL
<br />ADDRESS:
<br />(949) 399-5800; License #0437153
<br />Irene, CA 92614
<br />EACH OCCURRENCE $ 1,000,000
<br />Attu'. NewportBeach.CertRequest@mamh.com/F: 212948-4323
<br />INSURER(S) AFFORDING COVERAGE NAIC 0
<br />INSURER A: Hartford Fire Insurance Company — 19682
<br />412600-STND-GAWU-17-18
<br />INSURED
<br />Griswold Industries Cla-Val Inc.
<br />INSURERS: NIA N/A
<br />INSURER C : Twin City Fire Insurance Company 29459
<br />1701 Placentia Avenue
<br />INSURER o: Affiliated FM Insurance Company 10014
<br />Costa Mesa, CA 92627-4475
<br />INSURER E,
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: LOS -001794022-07 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 />NSR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />EFF
<br />MM% OA'YYV
<br />EXPR
<br />MLIY
<br />M�DD/YYYYY
<br />LIMITS
<br />A
<br />X
<br />I COMMERCIAL GENERAL LIABILITY
<br />X
<br />72ECSOA1987
<br />04/01/2017
<br />0410112018
<br />EACH OCCURRENCE $ 1,000,000
<br />CLAIMS -MADE E OCCUR
<br />DAMAGE TO
<br />PREMISES Ea occur ante $ 300,000
<br />X
<br />MED EXP (Any one person) $
<br />$1,000,000 SIR
<br />PERSONAL a ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L
<br />X
<br />POLICY PROJECT. [::] LOC
<br />PRODUCTS COMP/OPAGG $ 2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />72UENUM3154
<br />04/0112017
<br />04/01/2018
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />Ea accident
<br />BODILY INJURY(Per person) $
<br />X ANYAUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />POP RTY DAMAGEAUTOS $
<br />X HIRED AUTOS X NON -OWNED
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE $
<br />AGGREGATE $
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />$
<br />A
<br />C
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNEWEXECUTIVE YNI❑N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />72WN093100(CA) SIR -$750,090
<br />72WEH03564 (AOS)
<br />04101/2017
<br />04/01/2017
<br />04/0112018
<br />04101/2018
<br />X STATUTE ETH
<br />E. L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />D
<br />Property
<br />SX624
<br />04/0112017
<br />0410112618
<br />Blanket Property Limit 76,037,938
<br />Deductible 50,000
<br />DESCRIPTION OF OPERATIONS ILOCATIONS / 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 Is included as additional insured with respect to general liability where required by written contract, This insurance is primary and
<br />non-contributory with respect to general liability over any existing Insurance and limited to liability arising out of the operations of the named Insured and where required by written contract.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana, Its
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Officers, Employees, Agents,
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Volunteers and Representatives
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />of Marsh Risk & Insurance Services
<br />Pamela Petersen 4swai 4=41ille0i
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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