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iyE,,.... w CERTIFICATE OF LIABILITY INSURANCE
<br />DAT E(MMIDDIYYVV)
<br />06/28/2017
<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(ies) 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 />AGO Risk Services Northeast, Inc.
<br />New York NY Office
<br />CONTACT
<br />NAME:
<br />INC No. Ext): (866) 283-7122 AC. No.): (800) 363-0105
<br />EMAIL
<br />ADDRESS:
<br />199 Water Street
<br />New York NY 10038-3551 USA
<br />INSURER(S) AFFORDING COVERAGE NAIL#
<br />INSURED
<br />INSURER A: Great Northern Insurance Co. 20303
<br />ICF Jones & Stokes. Inc.
<br />Attn: Misha Frelmann
<br />9300 Lee Highway
<br />Fairfax, VA 22031 USA
<br />INSURER B: Federal Insurance Company 20281
<br />INSURER C: AXIS Surplus Insurance Company 26620
<br />INSURER D:
<br />INSURER E:
<br />Package -Domestic
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 570067269900 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 />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />MISS
<br />LTR
<br />TYPE OF INSURANCE
<br />ADD[
<br />INsp
<br />WVD
<br />POLICY NUMBER
<br />MMIDDIYYYY
<br />MMIDDNYYY
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />35612409
<br />EACH RRENCE $1,006,000
<br />CLAIMS -MADE X❑ OCCUR
<br />Package -Domestic
<br />MMATOEd ?T EDrce
<br />SESS(Ea occunce) $1,000,000
<br />PREMISES
<br />MED EXP (Any one person) $10,000
<br />X Contractual Liability
<br />PERSONAL BADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />X POLICY ❑ PROA ❑ LOC
<br />ECT
<br />pRODUCTS.COMP/On AGO $2,000,000
<br />OTHER:
<br />A
<br />AUTOMOBILE LIABILITY
<br />73522955
<br />Automobile - All States
<br />07/01/201707/01/2018
<br />COMBINED SINGLE LIMIT $1,000,000
<br />Ea accident
<br />BODILY INJU RV( Per parson)
<br />X ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLYAUTOS
<br />X HIRED AUTOS X NON -OWNED
<br />ONLY AUTOS ONLY
<br />BODILY INJU BY (Per
<br />PROPERTY DAMAGE
<br />Per accident
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />EXCESS LIAB
<br />CLAIMS -MAGE
<br />AGGREGATE
<br />DED RETENTION
<br />B
<br />EWORKERS MPLOYERCOMPPEEI` COMPENSATION AND
<br />ITY YIN
<br />ANY PROPRIETORI PARTNER I EXECUTIVE ❑
<br />OFFICERIMEMBER EXCLUDED? N
<br />NIA
<br />71754337
<br />Workers Compensation
<br />07/01/2017
<br />07/01/2018
<br />X STATUTE OTH.
<br />FIR
<br />E, L. EACH ACCIDENT $1,000,000
<br />E.L. DISEASE -EA EMPLOYEE $1,000,000
<br />(Mandatory In Ni
<br />If ye s, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />C
<br />E&O-sirimary
<br />EBZ768043/01/2017
<br />07/01/2017
<br />07/01/2018
<br />Prof Liab Agg - All $1,000,000
<br />Errors & omissions
<br />overall policy aggri $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aNached if more apace Is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insureds as
<br />their interests may appear with respects to General Liability.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />91988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS.
<br />City Of Santa Ana
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center P1aZa
<br />Po BOX 1988
<br />Santa Ana CA 92702 USA
<br />/✓,5�/{•. /�/�^/////+ y/�
<br />r•/% `-ter e/IGP.'lDA9c// ��e/9trA
<br />91988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
<br />
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