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ACORQ DATE(M MIDDNYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 1011012017
<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 the
<br />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 818-836-5800 CONTACT Andrea Eatou h
<br />Lockton Insurance Brokers, LLC 818-721-5800 NIAiol g FAx
<br />16633 Ventura Blvd., Ste. 1300 ac, IN Ext: 818-836-5833 AIc, No): 818-721-5833
<br />Encino, CA 91436 ADDRESS, aeatough@lockton.com
<br />INSURERS) AFFORDING COVERAGE NAIC#
<br />INSURER A: New York Marine & General Insurance Co. 16608
<br />INSURED KOCE-TV Foundation { INSURER B:
<br />PBS SoCaIINSURER C'.
<br />3080 Bristol Street INSURER D:
<br />Costa Mesa, CA 92626 INSURER E
<br />INSURER F :
<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 />INSR
<br />ADDL
<br />SUBR
<br />POLICY EFF
<br />POLICY EXP
<br />LTR
<br />TYPE OF INSURANCE
<br />...._......___.
<br />INSR
<br />Me
<br />POLICY NUMBER
<br />_
<br />MMIDDIYYYY)
<br />{MMIDD IYYYYf
<br />.. _ LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />_....._..
<br />1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />ETORENTED
<br />PREMIDAMASES
<br />PREMISES�(Eapcc, rrence
<br />' 100,000
<br />A
<br />CLAIMSMADE X__ OCCUR
<br />❑
<br />❑
<br />PK201600003723
<br />11/01/16
<br />11/01/17
<br />MED EXP(Anyone person)
<br />5 5,006
<br />PERSONAL B ADV INJURY
<br />1,000,00D
<br />GENERAL AGGREGATE
<br />2,000,000
<br />GEML AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS-COMPIOP AGO
<br />21000,000
<br />EMPLOYEE BENEFITS
<br />_.
<br />1,000,000
<br />PRO
<br />X POLICYFIJECTF LOC
<br />..,..._
<br />UTOMOBILE LIABILITY
<br />COMBINED SINGLE LIMIT
<br />1,000,000
<br />_
<br />0
<br />0
<br />AU201600003678
<br />11/01116
<br />11/01/17
<br />Be acaiaem)
<br />BODILY INJURY (Per person)
<br />ANY AUTO
<br />A`
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />....................................
<br />BODILY INJURY (Per accident)
<br />PROPERTYAGE
<br />X HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />(Per accident)ident)
<br />X
<br />UMBRELLA LIAB X_ OCCUR
<br />-..-
<br />....-.---
<br />............
<br />EACH OCCURR ENCE
<br />6,000,000
<br />A
<br />A
<br />EXCESS LIAB
<br />EXCESS LIABCLAIMS-MADE
<br />❑
<br />ElAGGREEGATE
<br />UM201600001281
<br />11/01/16
<br />11/01/17
<br />--
<br />6, 00000-0 -
<br />,
<br />DED L X RETENTIONS 10,000
<br />_ __
<br />ORKERS COMPENSATION
<br />W-
<br />CSTATU-
<br />TH
<br />AND EMPLOYERS' LIABILITY YIN
<br />X
<br />ORY LIMITS
<br />�FR
<br />ANY PROPRIETORIPARTNERI EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />FFICEIMEMBER EXCLUDED'
<br />NIA
<br />❑
<br />E. L. DISEASE EA EMPLOYEE
<br />Mandator, in NH)
<br />If,es, describe antler
<br />E.L. DISEASE POLICY LIMIT
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />Misc. Owned/Rented Equipment
<br />❑
<br />❑
<br />PK201600003723
<br />11/01/16
<br />11/01/17
<br />$225,000 / Ded. $1,000
<br />hird Party Property Damage
<br />$1,000,0001 Ded. $2,500
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers, and representatives are icludes lid Additional Insured, but only as
<br />Named Insured. Coverage
<br />respects to claims arising out of the negligence of the is primary.; tTeplson-Conti butory. I des 30-day notice
<br />of cancellation.
<br />. —
<br />CERTIFICATE HOLDER
<br />. __ .-__._ ........_...
<br />CANCELLATION •Q1N8
<br />CITY OF SANTA ANA
<br />SHOULD ANY OF ArggVE ED POLICIES BE CANCELLED BEFORE
<br />PARKS, RECREATION AND COMMUNITY SERVICES AGENCY
<br />THE EXPI N DATE E F, NOTICE WILL BE DELIVERED IN
<br />THEACCORDAN
<br />E WITH THE PROVISIONS.
<br />20 CIVIC CENTER PLAZA, PO BOX 1988 M-23, SANTA ANA, CA 92702
<br />"i
<br />AUTHORIZED REPRESE/nN7TA�-TI�JVE
<br />@ 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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