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A� O® CERTIFICATE OF LIABILITY INSURANCE <br />DAM(MMIDD/YYYY) <br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />01/04/2018 <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 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 <br />CONTACT Danielle Nihau <br />NAME: <br />Select5olutions Insurance Services <br />PHONE (866)500-6359 FAX (925)951-0077 <br />AIC No EXt: A/C, No: <br />1107 Investment Blvd <br />E-MAIL danielien@selectsolutionsins.com <br />EACH OCCURRENCE $ 1,000,000 <br />ADDRESS: <br />INSURER(S) AFFORDING COVERAGE NAIL p <br />Suite 100 <br />EI Dorado Hills CA 95762 <br />INSURERA: Philadelphia Consolidated Holding Corp <br />INSURED <br />INSURER B: New York Marne & General Insurance 16608 <br />Wiseplace, a Ca Corp <br />INSURER C: <br />1411 N. Broadway <br />INSURER D: <br />NSURER E: <br />Santa Ana CA 92706 <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 17/18 & 18/19 Master 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS <br />CERTIFICATE MAYBE 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 />LTR <br />TYPE OF INSURANCE <br />AUDL <br />INSD <br />SUEIR <br />MO <br />POLICY NUMBER <br />POLICY EXP <br />MMIDDIVYYY <br />LIMITS <br />COMM ER CIALGENERALLMBILITY <br />EACH OCCURRENCE $ 1,000,000 <br />CLAIMS -MADE 0 OCCUR <br />PREMISES Eaaccuonce $ 100'000 <br />MED EXP (Any one emon) $ 5,000 <br />FMWDD,/�Y <br />PERSONAL&ADV INJURY $ 1,000,000 <br />A <br />Y <br />PHPK1758146 <br />01/01/2019 <br />GEN'L AGGREGATE LIMITAPPLIES PER: <br />GENERALAGGREGATE $ 2.000,000 <br />X POLICY JERCT 7 LOC <br />PRODUCTS - COMPIOPAGG $ 2.000,000 <br />IS <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT $ 1,000,000 <br />Ea accident <br />X <br />ANYAUTO <br />BODILY INJURY (Per person) $ <br />A <br />OWNED F7 SCHEDULED <br />AUTOS ONLY AUTOS <br />PHPK1758146 <br />01/01/2018 <br />01/01/2019 <br />BODILY INJURY(Peraccident) $ <br />HIRED NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />PROPERTY DAMAGE $ <br />Per accident <br />Collisiion $ 1,000 <br />X <br />UMBRELLALIAB <br />OCCUR <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />EXCESS LIAR <br />CLAIMS -MADE <br />PHUB613132 <br />01/01/2018 <br />01/01/2019 <br />AGGREGATE $ 1,000,000 <br />DEO I X1 RETENTION $ 10,000 <br />$ <br />B <br />WORKERS COMPENSATIONPER <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NIA <br />WC201700006833 <br />08/15/2017 <br />08/15/2018 <br />OTF4 <br />X STATUE ER <br />E.L. EACH ACCIDENT $ 1.009,000 <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 />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />City of Santa Ana Is included as additional insured on General Liability policy per attached endorsement. General Liability coverage is <br />primary and non-contributory per the attached endorsement. The Professional Liability Limits shown represent the per claimlaggregate limits <br />of liability. <br />CERTIFICATE HOLDER CANCELLATION <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa Ana, Community Development Agency <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza, M-25 <br />AUTHORRED REPRESENTATIVE <br />Santa Ana CA 92701 <br />A.; �,r �-� <br />�F „"`'9 <br />©1988.2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD <br />