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ab, V/ AqA'7~w� ACORDV CERTIFICATE OF LIABILITY INSURANCE �� DarE lmm/oo YYvI 10/10/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE RTIFICATE 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(ies) 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 M3 Insurance Solutions, Inc. 828 John Nolen Drive CONTACT NAME: Lisa Acker PHONE FAX talc Ne Ext 608-288-2827 ac No: 608-273-1725 E-MAIL Do Ess: lisa.acker@m3ins.com INS URERS1 AFFORDING COVERAGE NAICN 101112019 EACH OCCURRENCE 51.000,000 INSURER A: Charter Oaks Fire Company 4COMMERCII CLAIMS -MADE OCCUR INSURED Total Administrative Services Corporation 2302 International Lane INSURERS: Travelers Property & Casualty 25674 INSURER C: JNSURER D: Madison, VVI 53704 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 833325211 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 LTR TYPE OF INSURANCE ADD L D! SUBR POLICY EFF D POLICY NUMBER MM/OD/YYYY POLICY EXP MM/DD/YYYY LIMITS A L GENERAL LIABILITY Y Y H5305A885588COF17 10/1/2018 101112019 EACH OCCURRENCE 51.000,000 4COMMERCII CLAIMS -MADE OCCUR 'DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10.000 PERSONAL 8 ADV INJURY $1.000000 GEHL AGGREGATE LIMIT APPLIES PER:. GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT D LOG PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ' BA5A1146137 I 10/12018 10/1/2019 COMBINED SINGLE LIMIT $1,000,000 Ea accident) ANY AUTO BODILY INJURY(Per person) $ Ix OWNED SCHEOULEU AUTOS ONLY AUTOS BODILY INJURY Per accident 5 ( iHIRED X l NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTYDAMAGE $ Per accitlenl $ B X UMBRELLA LIAB X OCCUR CUP6J097403 10/1/2018 10/112019 EACH OCCURRENCE $1,000000 EXCESS LIAB CLAIMS -MADE '_AGGREGATE S 1,000.000 BED I X I RETENTION$ 100M _ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N UBAJB91951 10112018 10/1/2019 X PER OTH- STATUTE ER ANYPROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMSER EXCLUDED? NIA EL EACH ACCIDENT $500,000 _ _-._-- — (Mandatory in NH) E. L. DISEASE -EA EMPLOYEE $500.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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. City of Santa Ana Attn: Purchasing Department 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ISI^ All rinhfs ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD