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AC" CERTIFICATE OF LIABILITY INSURANCE
<br />lh.
<br />DA
<br />10/3012017YI
<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 the
<br />teens 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 818-836-5800ONTACT
<br />Lockton Insurance Brokers, LLC 818-721-5800
<br />16633 Ventura Blvd., Ste. 1300
<br />Andrea Eatough n
<br />pI ME: AX
<br />ac, No Ext :818'836-5833 ac No , 818-721-5833
<br />Encino, CA 91436
<br />r DRESS: aeatough@lockton.com
<br />INSURERS AFFORDING COVERAGE NAIC#
<br />INSR
<br />NSURERA: New York Marine & General Insurance Co. 16608
<br />POLICY NUMBER
<br />INSURED KOCE-TV Foundation
<br />NSURER 8:
<br />PBS SOCal
<br />NSURER C:
<br />NSURER D:
<br />3080 Bristol Street
<br />NSURER E:
<br />Costa Mesa, CA 92626
<br />NSURER 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 MAV HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />ADDL
<br />SUBR
<br />POLICY EFF
<br />POLICY EXP
<br />LTR
<br />TYPE OF INSURANCE
<br />INSR
<br />WVD
<br />POLICY NUMBER
<br />MMIDDI
<br />MMIDD
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE 6 1,000,000
<br />A
<br />% COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX OCCUR
<br />❑
<br />❑
<br />PK201700003723
<br />11101/17
<br />11/01118
<br />DAMAGE TO RENTED 100.000
<br />PREMISES Ea occurrence
<br />MED EXP (Any one person) 10,000
<br />PERSONAL &ADV INJURY 1,000,000
<br />GENERALAGGREGATE 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG 2,000,000
<br />EMPLOYEE BENEFITS 1,000,000
<br />PRO-
<br />X POLICY JECT LOC
<br />UTOMOBILE LIABILITY
<br />0
<br />0
<br />AU201700003678
<br />11/01117
<br />11101/18
<br />COMBINED SINGLE LIMIT 6 1,000,000
<br />(Ea acoden0
<br />BODILY INJURY (Per person)
<br />ANY AUTO
<br />A
<br />AUUTOSS AUTOS AOSCHEDULED
<br />BODILY INJURY (Per accident)
<br />% HIREDAUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />(Per awdenp
<br />X
<br />UMBRELLA LIAB
<br />%
<br />OCCUR
<br />EACH OCCURRENCE 6,000,000
<br />A
<br />EXCESS LIAB
<br />CtAIM&MADE
<br />❑
<br />❑
<br />UM201700001281
<br />11/01/17
<br />11/01/18
<br />AGGREGATE t 6,000,000
<br />DED X I RETENTION$ 10,000
<br />WORKERS COMPENSATION
<br />ND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />FFICE/MEMBER EXCLUDED?
<br />NIA
<br />Cl
<br />STATU-
<br />X ORV LIMITS
<br />TH-
<br />ER
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />Mandatory In NH)
<br />f yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Misc. Owned/Rented Equipment
<br />❑
<br />❑
<br />PK201700003723
<br />11/01117
<br />11101118
<br />$225,0001 Ded. $1,000
<br />hird Party Property Damage
<br />$1,000 0 / Ded. $2,50
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space is required)
<br />""""""......������
<br />The City of Santa Ana, its officers, employees, agents, volunteers, and representatives are included as.dditional Ins d, but only as
<br />respects to claims arising out of the negligence of the Named Insured. Coverage is primary and non�bil ributory. In e3 30 -day notice
<br />f cancellation.
<br />CERTIFICATE HOLDER CANCELLATION "F_4 ",%w t�\T � /fy,
<br />CITY OF SANTA ANA SHOULD ANY
<br />PARKS, RECREATION AND COMMUNITY SERVICES AGENCY THE EXPIRAI
<br />20 CIVIC CENTER PLAZA, PO BOX 1988 M-23, SANTA ANA, CA 92702 ACCORDANCE
<br />CANCELLED BEFORE
<br />BE DELIVERED IN
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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