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ACG'Rta® CERTIFICATE OF LIABILITY INSURANCE <br />�...-� 1o/zo/2o1a <br />DATE Y) <br />10/17/2 10/17/2017 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT 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 />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER Lockton Insurance Brokers, LLC <br />CA License #01715767 <br />Three Linbareadet'D Center, Suite 600 <br />Sall Francisco CA 94111 <br />CONTACT <br />NAME: <br />PHONE FAX <br />AIC qExtk A/C, No): <br />ADDRESS: <br />Y <br />(415)568-4000 <br />_ INSURER(S) AFFORDING COVERAGE _ <br />NAIC# <br />INSURER A: National Fire Insurance CO Of Flaitford_ <br />20478 <br />INSURED Grail III _ <br />INSURED GoVjiehVery, LLC <br />_INSURER 8: The Continental Insurance Company35289 <br />INSURER C: <br />408 Saint Peter Street, Suite 600 <br />Saint Paul MN 55102 <br />INSURER D <br />INSURER E <br />INSURER F: <br />COVERAGES GRAINOI CERTIFICATE NUMBER: 14322949 REVISION NUMBER- xxxxxxx <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 />MBR <br />TYPE OF INSURANCE <br />ADD <br />SUER <br />POLICY NUMBER <br />EFF <br />PMDIDNYVY <br />MMY IDDIVYICY VY <br />LIMITS <br />A <br />X <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />N <br />N <br />6043664103 <br />10/20/2017 <br />10/20I2018 <br />EACH OCCURRENCE <br />$ 1,000000 <br />DAMAGE YO RENTED <br />P_ ER MISES(Eaoccurrencel <br />$ 1 000,000 <br />_ <br />MED EKE (Any on person <br />S 15,000 <br />GEN'L <br />PERSONAL & AOV INJURY <br />_ <br />$ 1,000 000 <br />AGGREGATE LIMIT APPLIES PER: <br />POLICY a JERCOPI'- I�u � LOC <br />OTHER: <br />GENERAL AGGREGATE <br />$ 2000000 <br />_PRODUCTS _COMP/OP ASS <br />$ 2 000 000 <br />$ <br />B <br />AUTOMOBILE <br />X <br />__ <br />X <br />LIABILITY <br />ANY AUTO <br />OWNED SCH AUTOS LED <br />AUTOS ONLY AUTOS <br />ALI CI X NON -OWNED <br />AUTOS ONLY AUTOS ONLY <br />Coin$100DX CollSI000Ded <br />N <br />N <br />6043664084 <br />10/20/2017 <br />10/20/2018 <br />COMBINED SINGLE LIMIT <br />Ea acciden0 <br />It1,000,000 <br />BODILY INJURY (Per person) <br />$ xxxxxxx <br />BODILY INJURY Per accident <br />_ ( _ _ I <br />$ xxxxxxx <br />PROPERTY DAMAGE <br />Per accjdentl <br />$ xxxxxxx <br />$xxx_xxxx <br />UMBRELLA LIAS <br />EXCESS LIAR <br />_ <br />OCCUR <br />CLAIMS -MADE <br />NOTAPPLICABLE <br />EACH OCCURRENCE <br />$ xxxxxxx <br />AGGREGATE <br />$ xxxxxxx <br />DED RETENTION$ <br />_ <br />$ xxxxxxx <br />B <br />B <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNERIEXECUTIVE YIN <br />OFFICER/MEMBER EXCI.UOEW IE <br />(Mandatory In NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />NIA <br />N <br />6043364067 (AQS) <br />6043364070 (CA) <br />10/20/2017 <br />10/20/2017 <br />10/20/2018 <br />10/20/2018 <br />PER OTH- <br />x STATUTE E <br />E.I.. EACH ACCIDENI <br />_ <br />$ 1 000 000 <br />E.L. DISEASE - EA EMPLOYEE <br />$ 1 000 000 <br />E.L. DISEASE -POLICY LIMIT <br />$ 1000000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedelo, may be altachad if mare space is requlred) <br />RE: Evidence of Insurance purposes only. 11"P e <br />® l <br />CERTIFICATE HOLDER CANCELLATION i/ <br />14322949 <br />City Of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ath Floor <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana CA 92701 <br />AUTHORIZED REPR �SE$yTATIVE� <br />````44\\,,1I11VVLL <br />CA ` <br />1 <br />© 1988.2015 ACORD CORPORATIb1M. All rights reserved. <br />ACORD 25 (2016/03) <br />The ACORD name and logo are registered marks of ACORD <br />