KOSMONT & ASSOCIATES, INC. (dba KOSMONT COMPANIES) (3) - 2017

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KOSM&AS-01 RSTFRNRFRr A� o` CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDY17 oniznol7 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 certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject 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 endorsement(s). PRODUCER License # OC36891 CONTACT Brett R Sternberg L ddy Martin Company 20300 Ventura Blvd. Suite 340 Woodland Hills, CA 91364 PHONE FAX (ac, No, Exl: (370) 478-2625 377 (ac, No): Ad^oRk: brett@lyddymartin.com INSURERIS) AFFORDING COVERAGE NAIC # PASO408465D4 INSURER A: Zurich American Insurance Company of Illinois 27855 06/2712018 INSURED INSURER B: Foremost SI nature Insurance Company 41513 Kosmont & Associates, Inc. Dba: Kosmont Companies INSURERC: PERSONAL& ADV INJURY $ Excluded 1601 N. Sepulveda Blvd. #382 INSURER D: INSURER E: Manhattan Beach, CA 90266 INSURER F; AUTOMOBILE X COVERAGES CERTIFICATE NUMRER- 11 RFVIq InN Nihil R• 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X Contractual Liab X PASO408465D4 06/2712017 06/2712018 EACH OCCURRENCE $ 1,000+000 DAMAGE TO RENTED 1,000,000 P ccurren MED EXP (Anyoneperson) $ 10,000 PERSONAL& ADV INJURY $ Excluded GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY [:1 PE8T LOC OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS - COMPIOPAGG 2,000,000 B AUTOMOBILE X LIABILITY ANYAUTO OWNED SCHEDULED OWqNEE�R ONLY AUTOS Al1TOS ONLY X AUTNO ONLB X PASO40846504 06127/2017 06/2712018 COMBINED SINGLE LIMIT1,000,000 Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ feOacc dent AMAGE A X UMBRELLA LIAB EXCESS LIAB X OCCUR ICLAIMS-MADE X PASO40846504 06/2712017 06127/2018 EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINI ANY PROPRIETOWPARTNER/EXECUTIVE MraISERWE atory BE EXCLUDED? ❑ We #yes, tlescdbe untler DESCRIPTION OF OPERATIONS below NIA I PER OTH- STAT E ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured 4� City of Santa Ana Attn: Marc Morley 20 Civic Center Plaza (M-25) Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD