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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE IMMIDOIYYYYI
<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 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 />PRODUCER
<br />\rthur J. Gallagher & Co.
<br />nsurance Brokers of CA. LIC #0726293
<br />t1011 Warner Center Lane
<br />Noodland Hills CA 91367
<br />INSURED _
<br />Downey Vendors
<br />5814 Suva Street
<br />Bell Gardens CA 90201
<br />81
<br />INSURER West American Insurance Company
<br />INSURERS American Fire and.. Casualty Company
<br />O11VPRAOFS ne0TIL91-A7= w,aeoeo. lC.1RRR7R97 .. �..,......, .�......__
<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
<br />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--....._._..... DOL-SUB77-__._._—_.—_._ _
<br />LTR TYPE OF INSURANCE PULICY EFF POLICY E%P
<br />Ir WVD'. POLICY NUMBER -. MMIDDIYYYY MIODfYI'YY
<br />----------.""---'— -
<br />LIMITS
<br />A X COMMERCIAL GENERAL LIABILITY Y BKVV56585014-4/1/2017 4/112018
<br />^�'
<br />EACH OCCURRENCE $1000000 -
<br />CLAIMS -MADE XOCCUR
<br />^OAMAGETORENTED ...-...-_..__--
<br />; PREMISES (Ea occurrencaj ,$100000
<br />____ __ _... ',.
<br />MED EXP(Any one person) 510,000 -- -
<br />PERSONAL&ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />GENERALAGGREGATE I$2,000,000
<br />X _ POLICY PRO JELDC ,.. _
<br />CT
<br />''. PRODUCTS-COMP/OP AGO - $2,000.000
<br />_.........
<br />OTHER;
<br />......_
<br />A AUTOMOBILE LIABILITY -BAW565B5014 4/1/2017 4/1/2018
<br />COMBINED SI LIMIT
<br />.aaccident__ ''.. $1,000,000
<br />-
<br />XANY AUTO ',
<br />;BODILY INJURY (Per person) ', $
<br />. OWNED '. SCHEDULED
<br />AUtOSONLY AUTOS
<br />BODILY de--------
<br />LY INJURY (Par acc nt) $
<br />X ` HIRED X" NON-0WNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROP
<br />PROPERTY
<br />:PROPERTY DAMAGE
<br />MADE $
<br />-
<br />c
<br />Unlined moto Com '.$1,000.000
<br />B X 11 UMBRELLA LIAO _X OCCUR -'. USA56585014 411/2017 4/1/2018
<br />EACHOCCURRENCE $10,000,000
<br />EXCESS LIAR CLAIMS -MADE
<br />AGGREGATE $10,000,000
<br />DED I RETENTIONS
<br />- $
<br />WORKERS COMPENSATION
<br />PER TH-
<br />'.ANDEMPLOVERWLIABILITY YIN
<br />8rAI UrE... ER
<br />ANY PROPRIETORIPARTNFWEXECUTIVE ❑ NIA
<br />OFFICERIMEMBER EXCLUDED?
<br />EL EACH ACCIDENT $
<br />- -- __.......___..
<br />(Mandatory in NH)
<br />ELDISEASE-EAEMPLOYEE_$
<br />yes, describe antler
<br />D
<br />DESCRIPTION OF OPERATIONS below
<br />E L DISEASE -POLICY LIMIT $
<br />A Hired Auto PC BAW58565014 Hired Auto PD 4/1/2017 4/1/2018
<br />Comp & Coll Ded�.\ _ $50,000
<br />i
<br />a $1,000
<br />0
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES(ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) �\ a
<br />Re: Operations of the Named Insured for the Certificate Holder.
<br />!}.� ,{�.'` ���
<br />City of Santa Ana, Santa Ana City
<br />Hail, Santa Ana Police Dept., Santa Ana City Santa Ana City
<br />CJ
<br />and Yard and Santa Ana
<br />Library of Santa Ana its officers, employees
<br />agents, volunteers and representatives are named Additional Insureds with Primary Wording per attached
<br />'�4U\,88q,0 D413,
<br />City of Santa Ana
<br />20 Civic Center, 8th Floor
<br />Santa Ana CA 92702
<br />ACORD 25 (2016/03)
<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 />REPRESENTATIVE
<br />©1988.2015
<br />The ACORD name and logo are registered marks of ACORD
<br />rinhfe ra¢orved
<br />
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