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" aP° CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MMIDIVYYYY) <br />11/12/2018 <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 be endorsed. If SUBROGATIONIS 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 <br />BIZINSURE LLC/PHS <br />CONTACT <br />NAME: <br />OUCY-EPP <br />D <br />POUCYEXP <br />57102005 <br />COMMERCIAL GENERAL LWBWTY <br />THE HARTFORD BUSINESS SERVICE CENTER <br />3600 WISEMAN BLVD <br />SAN ANTONIO, TX 78265 <br />(AIC, o, Est): (866) 467-8730 <br />FAX <br />No): (888) 443-6112 <br />E-MAIL <br />CLAIMS -MADE OCCUR <br />ADDRESS' <br />INSURER(S) AFFORDING COVERAGE NAICN <br />INSURED <br />INSURER A: The Twin City Fire Insurance Company <br />29459 <br />Hall Aquatic Life Support Designs DBA Hall Aquatic Design LLC <br />INSURER a: The Hartford Accident and Indemnity <br />22357 <br />347 GRANT ST SET� <br />ATLANTA GA 30312-2226 Iij -3C)-7 —LAe0 <br />Insurance Company <br />INSURER C: <br />A <br />57 SBM BL2522 <br />INSURER D : <br />11/09/2019 <br />1 <br />INSURER E: <br />PERSONAL SADV INJURY <br />INSURER F: <br />GENERAL AGGREGATE $4,000,00 <br />COVERAGES CERTIFICATE NUMBER: 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 <br />TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSF <br />TYPE OF INSURANCE <br />ADDL <br />INSR <br />SUB_POU <br />CY NUMBER <br />OUCY-EPP <br />D <br />POUCYEXP <br />LIMITS <br />COMMERCIAL GENERAL LWBWTY <br />EACH OCCURRENCE $2,000,00 <br />CLAIMS -MADE OCCUR <br />DAMAGE TORENTEDPREMISES Ea ocunn $1,000,00 <br />X <br />MED EXP (My one person) $10,00 <br />X General Liability <br />A <br />57 SBM BL2522 <br />11/09/2018 <br />11/09/2019 <br />1 <br />PERSONAL SADV INJURY <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $4,000,00 <br />PRO- <br />LOC <br />POLICY F] <br />PRODUCTS-COMP/OP AGO $4,000,00 <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT $2,000,00 <br />(Ea soon ant) <br />INJURY (Per person) <br />ANY AUTO <br />A <br />ALL OSMED SCHEDULED <br />No, <br />X HIREDAUTOS NTO$ <br />57 SBM BL2522 <br />11/09/2018 <br />11/09/2019 <br />�e�`e <br />DILVIAUTI�NJURV (Pare' <br />PRrOPERT DA <br />U 112P <br />UMBRELLA LAB <br />OCCURR <br />EXCESS UAB <br />CLAIMS -MADE <br />00 0 <br />-- 11 <br />G <br />DED <br />RETENTIONS <br />✓ <br />WORKERS COMPENSATION <br />PER X OTH- <br />ANDEMPLOYERTUABILRY <br />STATUTE ER <br />E.L EACH ACCIDENT $1,000,00 <br />B <br />ANY PROPRIETORPARTNERIEXECIIrIVE YIN <br />OFFICERIMEMBEREXCLUDED' <br />(Mandatory In NH) <br />MA <br />57 WEC AC3MZN <br />11/09/2018 <br />11/09/2019 <br />E.L. DISEASE -EA EMPLOYEE $1,000,00 <br />If yes, describe under <br />DE PTION F PERATI below <br />E. L. DISEASE - POLICY LIMIT $1,000,DD <br />A <br />EMPLOYMENT PRACTICES <br />LIABILITY <br />57 SBM BL2522 <br />11/09/2018 <br />I <br />11/09/2019 <br />Each Claim Limit $10,00 <br />Aggregate Limit $10,00 <br />DESCRIPTION OF OPERATIONS/LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be allachad N mom apace u required) <br />Those usual to the Insured's Operations. The city of Santa Ana, it's officers, employees, agents and representatives are named as additional insured per the <br />Business Liability Coverage form, SS0008, attached to this policy. 30 Day Notice of Cancellation applies. <br />CERTIFICATE HOLDER CANCELLATION <br />THE CITY OF SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 CIVIC CENTER PLZ <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />SANTA ANA CA 92701-4058 <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />/ <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />