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' C?RbeCERTIFICATE OF LIABILITY INSURANCE GATE (MM/I 1/2.5/20185/2018zDle 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 pollcy(les) must 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 hostler In lieu of such endorsement(s). PRODUCER NAMEACT Chip FrarlOie MIDC YYY POLICY EFF PWONE (626)396-1035 FAX ,(628)396-1048 Kelley Jiggins and Associates Insurance Brokers EMAIL ,chipQkj ains. oom PO Box 60310 Pasadena CA 91116-6310 INSURERS AFFORDING COVERAGE NAIC Yr INsu ERA:Ohio Saou=itv 27082 INSURED INSURER B:American Hire S C&SUaltV Co 24066 INSURER C EACH OCCURRENCE_ g 1r000, 000 MDG Associates, Inc. SURER DI 10722 Arrow Rotate STB 822 INSURER E: •� _ Rancho Cucamonga CA 91730 INSURER THIS IS 70 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. INR LTR TYPE OF INSURANCE AU0 S a POLICY NUMBER MIDC YYY POLICY EFF POLICY EXP LIMITS A1-21 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR EACH OCCURRENCE_ g 1r000, 000 PRE SES - urr ) S 200,000 X y 0=57179290 7/1/2011 7/1/2018 MED EXP (Any oneadman) $ 18,000 PERSONAL&ADV INJURY $ 1,000,ODC G EN'L AGGREGATE U MIT APPLIES PER; X POLICY PRO- ❑ JECT LOC 1 GENERAL AODRECATE $ 2,000,000 PRODUCTS-COMP/OP AGO $ 2,000,000 Employee BeneflE $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINcddED G IT 8 1,000,000 A X ANY AUTO AILL OWNED �IgDULED .X y. BASS1179298 7/1/2017 7/1/2018 BODILY INJURY (Per person) $ BODILY INJURY (Per aocldent) $ X HIRED AUTOS X NON -OV EO AUTOS PR P TY DAMAGE b Medical amenk b 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE S 4.000,000 D X EXCESS LIAR CLAIM&MADE AGGREGATE S 4 Doc 000 DED RETENTION S 0SAS7179298 7/1/20aT 7/1/2018 WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNEWEXECUTNE OFFICERAIEMBER EXCLUDED? (Mandatory In NH) Fyes, describe under NIA FSR OT - U E ER E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarics Schedule, may he auaehad If more space Is required) The City of Santa Ana, Its officers, employees, agents and volunteers and named additional insured, but only as respeeys the insured's operations as it relates to their signed contract in regards to the CDBG Administration Consluting Services per form CG8810 0413Primay Insurance and Transfer of rights or recovery against others is included in the form, Auto AI CABB10 0113 *30days notice of cancellation except 10 days for non-payment. City of Santa Ana Attn.: Terri Eggers, Senior Mgmt, Analyst Community Development Agency 20 Civic Center Plaza Santa Ana, CA 92701 SHOULO ANY OF THE ABOVE DESCRIBSD POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Jiggins/CHIP Q 1999.2074 ACORD CORPORATION. all r•inhfc mearvnx ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401)