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A� n' CERTIFICATE OF LIABILITY INSURANCE .-T�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 certificate holder is an ADDITIONAL INSURED, the policyles) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions ofthe 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 M3 Insurance Solutions, Inc. 828 John Nolen Drive Madison WI 53713 mari NAME: LIPHONE Arc No Ecit 6 082 882 826 ac, rvo: EMAILLDDRESS: cath .'ehnBm3ins.com ER 'FOR CUSFOMER IO p: TOTAA-1 Y INSURE US) AFFORDING COVE MG E NAICW 10/1/2017 INSURED INSURERA: Travelers Pro ert & Casualtv 25674 Total Administrative Se TVlces Corporation 2302 Inte rnatronal Lane INSURERB:The Travelers Indemnitv Co. of Corin INSURER C: Travelers Indemnitv of America 25666 Madison WI 53704 INSURER D CLAIMS MADE OCCUR INSURER E INSURER F MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER: 1378362495 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. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTI FICATE MAY BE I SET ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI N IS SUBJECT TO ALL THE TERM S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOSNV MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE Attn: Purchasing Department POLICY NUMBER POLICY MM MWDDNYY) LIMITS C GENEML LIABILITY Y Y H630SX888588COF19 10/1/2017 10/1/2018 EACH OCCURRENCE $1,000,000 PREMISE (Ea occurrence) $500,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED EXP (Any one person) $10,000 PERSONAL&ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGRE A PODUTS-OMPOPA$2,000,000 POJCYGRm PLIMIT LPC $ A AUTOMOBILE LIABILITY BASA114687 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BOD LY ICU RY(Re r person) $ ALL OWN ED AUTOS BOD LY ICU RY(Re r accident) $ SCHER ULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) $ NONOWNED AUTOS $ A X BMBRELIA LIAB N OCCUR 1UNnm LW88588TIL17 10/1/2017 10/1/2018 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 EXCESSLIAB CIAIMSMADE DEDUCTIBLE $ $ X RETENTION $10,000 B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YEN HEVB8017C97617 HDTEEDB8022C68SI7 10/1/2017 10/1/2017 10/1/2018 10/1/2018 X WC bLATU- OTH- TORY LIMITS ER ANYPROPRIETOR/PARTNEDEXECUTIVE❑ EL EACH ACCIDENT $500,000 OFFICERMIEMBER EXCLUDED9 NJA EL DISEASE -EA EMPLOYEE $500,000 (MandanoWin NH) I!y describe under I SCRIPTION OF OPERATIONS below ELDISEASE -POIJCYLIMIT $500,000 OESCRIPTIDN OF OPERA IIS/LOCALONS/VEHICLES(Adman ACORD 101, Addi Tonal Remarks Schedule, if more space is required) Umbrella is Excess of Employers Liability, Auto and General Liability. Certificate holder, its officers, agents, and employees are additional insureds with respect to General Liability per attached CG D417 0112. Notice of Cancellation provided per policy provisions. CERTIFICATE HOLDER CANCELLATION © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED City of Santa Ana IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Purchasing Department 20 Civic Center Plaza Santa Ana CA 92701 AOTHOREED REPRESENTALVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD