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Policy Number 73APS073685 Date Entered: 08/17/2017 <br />m <br />CERTIFICATE OF LIABILITY INSURANCEDATE(MMIOLffYM <br />LIR <br />TYPE OF INSURANCE <br />10/24/2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFUM11VELY 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 pollcy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />if SUBROGATION IS WAIVED, subject to the teens and conditions of the policy, cortnin policies may require an endorsemont. A statement on <br />this certificate does not confer rights to the certificate holder In ,feu of such endomement(s). <br />PRODUCER Interstate Trans Insurance Broker Inc. <br />P.O.BO]C 911094 <br />Commerce, Ca 90091 323-728-0003 <br />vN,0NTAcT Sa= SX #OG22050 <br />PH FAX <br />oNE . (323) 728-0003 323) 888-2331 <br />No <br />Ii -MAIL it3b2O000aol. com L:Lc# OG22050 <br />-Amems <br />INSURER S AFFORDING COVERAGE NAICN <br />X <br />I A•A'1'&IN SPECIALTY INSURANCE COMPAW 17159 <br />INSURED xxTo22iA.TIONAL ws X<nws INC <br />INSURER 0: IM=CML LIABILITY a BMW =SURAt1'C.Ei CORS 20052 <br />07/02/2019 <br />INSURER C: z9wSTCN SCE CcmpANY 37362 <br />2088 WEST BII+LCREST DR B208 <br />NEYMOR7L PARR, CA 91320 <br />INSURER D: 35076 <br />INSURERE• <br />INSURER F: <br />GEM AGGREGATE LWJTAPPLIES PER: <br />POLICY ❑ im M LOC <br />OTHER <br />L:UvEkALatD liCK11F1[:AI C NdamtlCK: RFVIRICIM M"Rffn=®. <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 />LIR <br />TYPE OF INSURANCE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />SUBR <br />POLICYRUMBER <br />PM CYEFP <br />POIDDA1110' <br />LIMITS <br />A <br />COMiE:RCIALGENERALLIABILITY <br />CLAIMS -MADE ® OCCUR <br />X <br />I <br />CXP322974 <br />1 <br />07/02/2017 <br />07/02/2019 <br />EACH OCCURRENCE $2,000,000.00 <br />-PREMI ® $ 500,000.00 <br />MEDEXP An ,son S 5,000.00 <br />PERSONAL & ADV INJURY S <br />GEM AGGREGATE LWJTAPPLIES PER: <br />POLICY ❑ im M LOC <br />OTHER <br />GENERA. AGGREGATE $2,000,000.00 <br />PRODUCTS -COMPIOPAGG S <br />3 <br />B <br />AUTOMOBILE LIABILITY <br />ANYAum <br />D K71 <br />AUTOSONLY AUTOS <br />AAUUTOS ONLY ED A OS ONLY <br />X <br />73APSO73685 <br />06/22/2017 <br />06/22/2019 <br />INGLE acrtdantl IMff $5,000,000.00 <br />BODILYINJURY(Perpersal) $ <br />BODILY INJURY(Paraceldenl) S <br />CaW WRW GE $ <br />$ <br />C <br />UMBRELLA LIR <br />EXCESSLIAS <br />OCCUR <br />CLAIMS—MADE <br />x <br />XDBW7268517 <br />EXCESS GLIMIiAL LTAB <br />09/16/2017 <br />7/02/20x9 <br />EACH OCCURRENCE $3,000,000.00 <br />AGGREGATE $ <br />DED I I RETEMION <br />EXESS FIRE LGL S 500,000.00 <br />Li <br />WORKERS COMPENSATION <br />AND EMPLOYERS LIABILITY <br />ANYPROPRIEfOR/PARTNE1RMOUTNE YIN <br />OFFtCEWMEMSEREXCLUDEC? Q <br />(Mandatary In NH) <br />0d0W"' <br />PC'OFOPERATIONS <br />N/A <br />9170728 <br />06/19/2017 <br />06/19/2019 <br />- . - <br />EJ_EACHACCtDENT $1,000,000.00 <br />E L. DISEASE -EA EMPLOYEE $1,000,000.00 <br />E.L. DISEASE -POLICY LIMIT 31,000,000.00 <br />DESCRIPTION OF OPERATIONS/ LOCATIONS! VEHICLES (ACORO 101, AdsOUonal Remand Schadula, maybe attaches! Umom apaca, Is mgalmd) <br />Commercial Livery Packaged Policy. <br />*** certificate holder Is named as additional insured *** <br />New Location: SANTA ANA, CA 92701 <br />l E\�€EWED BY: 6� EUNICE HEREDIA (FC, OF <br />.._... ......... _ N --- . ........ <br />Kai =491=10F.12 x:16101 *]=I: N.�a r.I d ■ �:r. ra.� <br />CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />SANTA ANA REGIONAL TRANSPORTATION CENTER <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />1000 E. SANTA ANA BLVD. SUITE 108 <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />SANTA AIM, CA 92701 <br />VAX -714-565-2692 <br />AUTHo REPRESENTATIVE <br />SALE x xMM INC <br />cv 1588.201EACORD CORPORATION. All rights reserved. <br />ACORD 26 (2016103) The ACOR13 name and logo are registered marks of ACORD <br />Produced using Forms Bass Pius software. www.FormsBass.com: lmoresslve Publishina 800-208-1977 <br />