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coRnm CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 12/14/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the cortiflcate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVEG, aub)ect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER The Empire Company 10201 Trademark St., Suite D N-2017-014 P.O. Box $400 Rancho Cucamonga CA 91729 n Cathy NegrOn PHONE E ;(909)476-0600 nX :ll aTc-0101 i41AIADDR681— onegroa®empire-co,cam INSURERS AFFORDING COVERAGE HAD INSURER A:Travelere Casualty Insurance 19046 INSURED ProBath, Inc. 17891 Cartwright Rd. Ste 100 Irvine CA 92614 ISURERs:Stata Co enaation Ina. Pond 35076 INsuRERc:Landmark American Ins. Co. 33138 INSURERS: INSURERS: PR Emml— d 300,000 INSURER F. COVERAGES CERTIFICATE NUMBER:17/18 MASTER REVISION NUMBER: - - - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE INSD ACCORDANCE WITH THE POLICY PROVISIONS. POLICYNUMB P I EF 1 LIMITS A X—COMMERCIALdENEHAL'LIABILITY.":: CLAIMS-M40E ❑X, OCCUR Cathy Nagron/NBORON EACH OCCURRENCE d 2,000,000 PR Emml— d 300,000 MEO EXP (My weperson) B 51000 X 650-9061R40B-17.42 9/25/2011 9/25/20110 PERSONAL d AOV INJURY B Excluded GEML AGGREGATE LIMIT APPLIES PER: X POLICY ❑ TER ❑ LOC GENERAL AGGREGATE $ 41000,000 PRODUCTS•COMPIOPAGO s4,000,000 d OTHER, AUTOMOME:LIABILITY E $ 11000,000 BODILY INJURY (Par Pamce) $ A ANY AUTO AALLOWNED �OEDULED 600.906IR408.17.42 9/25/2017 _.... 9/25/2019-'90DEYINJURY(Per ecdden0 B X HIRED AUTOS X ANOTNOOSM PROP d d UMBRELLA LJABOCOVR EACH OCCURRENCE $ AGGREGATE EXCESS LIA$ GLAIM&MADE DEC I I RETE WORKERS COMPENSATION AND BMPLOYERS'LIABILITY YIN ANY PR PRIETORRIEAXCNTLUOE09N:CUTNE ❑ OFFB (Mandelary In NH) 9 d Iba under 'RIPI NIA 9156086.2017 4/1/2017 4/1/2018' I( R E.L. EACH ACCIDENT $ 1,000 000 EL DISEASE - EA EMPLOYE S 11000,000 EL DISEASE -POLICY LIMIT $ 00-000 D N OPERATIONS b C PROPESSIONAL LIABILITY LBR8810o5 1/1/aglT 111/aa18 PER CLAIM LIMIT $1,000,000 INCL SEXUAL HISCONODCT ANNUALAGGREGATE $1400,000 DESCRIPTION OF OPERATIONS I LOCATION5IVEHICLES (ACORD 401, Additional Aemerks Schedolo, maybe attached emote apace Is regolrad) The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insured where regµired by written Contract per attached forms. Coverage is Primary and Nan -contributory. (CO D2 47 OB 05) (C(I DO 37 04 09) CERTIFICATE HOLDER CANCELLATION DSanchezRsanta-ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Community Development Agency THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Economic DaV. DiVinsion/Santa Ana WDB ACCORDANCE WITH THE POLICY PROVISIONS. 1000 E. Santa Ana Blvd. AUTHORIZED REPRESENTATNE Suits 200 Banta Ana, CA 92701r-� Cathy Nagron/NBORON © 9988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401)