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<br />A%C R& CERTIFICATE OF LIABILITY INSURANCE
<br />n11/2s/ oi7Y'
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) 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 />ONT
<br />Willis of Seattle, Inc.NE
<br />t). 3-877-995-7978 FAX, NCI: 1�Ba8-467-2378
<br />PHO�o ezAIL
<br />c/o 26 Century Blvd
<br />ADUSE , cartificatasQwillia.cwm
<br />P.O. Box 305191
<br />IN8Uit_ER{Sj AFFORDING COVERAGE
<br />r NAIC9
<br />Nashvilla, IN 372305191 USA
<br />A
<br />INSOREII Covert's Specialty Insurance Company
<br />15686
<br />INSURER'; Greenwich Insurance Company
<br />v 22322
<br />Cara Ambulanoa Ssrvioes:. Ino.
<br />-.— __...._._........._._ _ _.�
<br />_ .,„„_...,._
<br />1517 West araden Court
<br />_tNSUREij CSteadfast Insurance Company
<br />INSURER
<br />?.6967
<br />Orange, CA 92883
<br />INSURERD: XL Specialty Insurance Company
<br />376a5
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />INSURERS_._....708
<br />��____...._. �_,
<br />..........__.__
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: W4491393 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN'1ft
<br />-'"._...__'TYPE OF INSURANCE AODL
<br />8U8
<br />, ��POLICY NUMBER
<br />PoLICYBFF
<br />PPLICY a
<br />LIMITS �
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMEINADE I OCCUR
<br />EACH S 1,000,000
<br />TO
<br />DAMAGE�� 1 400,000
<br />P. EMISES Es accurterica S _
<br />X
<br />A
<br />Products Claims Made
<br />MED EXPCj:nY one Person) Is 5,000
<br />w y
<br />5^10013
<br />10/01/2017
<br />10/01/2018
<br />PER30NAL&ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE S _.. w 2,000,000
<br />X POLICY ❑ JEEl LOC�....m•
<br />PRODUCTS-COMP/OP ADD $ 2:000,000
<br />_—
<br />OTHER;
<br />S
<br />AUTOMOBILE
<br />LIABILITY
<br />COMOINEDSINGLE LIMITS 1,000,000
<br />Es eccIdenl
<br />X
<br />ANYAUTO
<br />BODILY INJURY (Per person) S
<br />B
<br />AUTOS SCHEDULED y
<br />AUTOS ONLY AUTOS
<br />MS00047602
<br />30/01/2017
<br />10/01/2018
<br />BODILY INJURY(Pafeccldam) S
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE ~^
<br />(Perawlden0 S ...
<br />C
<br />X
<br />UMBRELLACIAD
<br />EXCESS CIA'
<br />X
<br />OCCUR
<br />CLAIM"ADE Y
<br />UHB5414770-04
<br />16/0112017
<br />10/01/201.3
<br />EACH OCCURRENCE 5 1S, UOD,000
<br />AGGREGATE S 15,000,000
<br />DED I I RETENTIONS
<br />Is
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'UASIUTY
<br />ANYPROpRiETORtPAAINERIEXECVTiVE YIN
<br />OFFiCERIMEMDEREXCLUOEA? o NIA
<br />tMendatory in NHi
<br />RWD3000955-02
<br />3010112017
<br />10(01/2018
<br />X I STATUTE ERS
<br />_ ----
<br />EL_EACH ACCIDENT S 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,000
<br />If ea, tlesaite under
<br />R FOPERATIONS below
<br />E.L. DIS&$E•POLICY LIMIT S 11000,000
<br />A
<br />Mian Medical Professional.
<br />5-10013
<br />10/01/2017
<br />10/01/2013
<br />Per Claim $1,000,000
<br />Liability
<br />Aggregate $2,000,000
<br />Claims Made
<br />Abuse 6 Molestation $1,000,000
<br />DESCRIPTION OF OPERATIONS LOCATIONS/ VEHICLES (ACORD 191,Additlonal Remarks Schedule, maybe attached flmorc space Is Im9ulse)
<br />11 Lr 1
<br />This Voids and Replaces Previously Issued Certificate Dated 10/24/2017 WITH ID; W4092490.
<br />///!
<br />Umbrella/excess Fallows Form. Pa5z /�
<br />J RR'4010yKI
<br />The City of Santa Ana and their respective officers, officials, employees, representative and volunteers are included
<br />as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions
<br />CERTIFICATE HOLDER CANCELLATION
<br />01088.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />US M 15362924 sATM 526623
<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 />The City of Santa Ana
<br />20 Civic Center Pxaaa
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />01088.2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />US M 15362924 sATM 526623
<br />
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