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CERTIFICATE OF LIABILITY INSURANCE ( DATE,MMI°°fYYYY7
<br />cta Iona l
<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 poiicy{ies) must have ADDITIONAL INSURED provisions 01, be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement, A statement on
<br />this cortiHcato does not confer rights to the certificate holder in lieu of such endorsement(s).-
<br />PRODUCER CONTACT
<br />Arthur J. Gallagher Risk Management Services, Inc.
<br />PHONE
<br />(510 745-0800 FAX
<br />A ° H ) Nel:{516) 745-0082
<br />One Jericho Plaza Suite 200
<br />.Exp: (AIG
<br />Jericho, NY 11758-
<br />L aooR
<br />ADDR Ess:
<br />INSURERS) AFFORDING COVERAGE NAZCA j
<br />INSURER A: Federal Insurance Company :20281
<br />INSURED
<br />INSURER a Great Northern Insurance Company 1..20303 1 I
<br />Queens Borough Public Library
<br />INSURER e:
<br />89-11 Merrick Blvd.
<br />INSURER D: !,
<br />Jamaica, NY 11432
<br />INSURER E
<br />INSURER F:___....-.....
<br />COVERAGESCERTIFICATE NUMBER:
<br />REVISION NUMBER___
<br />THIS IS 10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW
<br />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 FFSPEC.I TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PER"rAIN, THE INSURANCE AFFORDED
<br />BY THE POL.ICIFS DESCRIBED HEREIN IS SUBJECTTO ALL. THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_
<br />I INS" 'ADDL'SUOR
<br />L LIE, TYPE VF INSURANCE TURG, W};p POLICY NUMBER1nfLv1fOPIYYYY)
<br />POLICY EFF POLICY EXP
<br />iMMePS1fYYYY',-___, LIMITS
<br />"__
<br />p A : X COMMERCIAL GENERAL LIABILITY
<br />_ —
<br />EACH OCCURRENCE $ 1'000'000}
<br />i CLAIMS MADE X ` OCCUR :OL--- 9949 69 92
<br />06791(2017 0610112018 DAMAGE 10 RENTED � 1,000,000
<br />PREMISES {EA occurrencsi
<br />j
<br />10*0001
<br />MED EXP G,ny ole person) IX
<br />1,000,0001
<br />„PERSONAL&AEG INJURY $ 1
<br />GEN L AEGA EGA I' G LIMIT APPLIES PER
<br />GENERAL AGGREGA IC i 21000,0001
<br />1, POLICY IIRCQr X LOC '.,
<br />PRODUCTS -COM PIOP ACU ` Included!!
<br />OTI IER
<br />B"
<br />AUTOMOBILE LIABILITY
<br />COMBINED
<br />COMBINED SINGLE LIMIT "-1,000,000
<br />auc tle n( ''., 5
<br />X ANY AU 10 73598196
<br />0610112017,,06/01/2018 BODILY INJURY (Per peso) $
<br />OWNH'J SCHEDULED
<br />AUTOS ONLY - AUTOS
<br />BODILY INJURY (Per .,,NLni) $
<br />DAMAGE
<br />ROUIaONLY NON-0�NED
<br />(PROPERitlY r,
<br />UMBRELLA LiAB OCCUR
<br />EACH OCCURRENCE S
<br />EXCESS LAS CLAWS -MADE
<br />AGGREGATESPER
<br />HL (ENTION $.
<br />COMPENSATION
<br />COM
<br />TniUTE ORi
<br />AND EMRS
<br />AND EMi>LOYERS i-IABWry
<br />YtN
<br />'
<br />WORKERS
<br />GR/PART NERIEXECU LIVE
<br />EL EAU I AOCIDEN'1 $
<br />OEFICENMEMpp{V�-�g,EXCLUDED" NIA
<br />[
<br />(Mandarory h', NH(
<br />E. L. DISEASE LA EMPLOYEE$
<br />If yeS debcl'hb0 natter
<br />DESCRIPTION OP OPERAPOPIS below
<br />EL DISEASE POLICYLIMIT '. $ i
<br />I
<br />6y�o
<br />x-�
<br />_ _O_F R I LOCATIONS I VEHICLES
<br />(05-07 101, Additional rtemarQs Schedule, may ba atlached If mo,e apac® Is repmred)
<br />ADDI HONAL INSUREDPER FORM 1105-07+..•'
<br />kThe City of Santa Ana, its officers, employees, agents, and representative are included
<br />as Additional insureds
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />City of Santa Ana
<br />Attn: PRCSA
<br />20 Civic.. Center Plaza -Ross Annex
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE. ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />���&O
<br />ACORD 25 (2016103) Oc 1988-2015 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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