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CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/oa/oz/2018 Y) <br />DD/Y <br />ola <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If <br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this <br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />PRODUCER <br />Aon Risk Services South, Inc. <br />Atlanta GA Office <br />CONTACT <br />NAME: <br />(A/CC.NNo. Ext); (866) 283-7122 (ac No.); (800) 363-0105 <br />E-MAIL <br />ADDRESS: <br />3550 Lenox Road NE <br />suite 1700 <br />Atlanta GA 30326 USA <br />INSURER(S) AFFORDING COVERAGE NAIC # <br />INSURED <br />INSURERA: LeXington Insurance Company 19437 <br />U. S. Security Associates, Inc. <br />200 Mansell East, 5th Floor <br />Roswell GA 300760076 USA <br />INSURER B; Lloyd's Syndicate No. 2003 AA1128003 <br />INSURER C: Liberty Mutual Fire Ins CO 23035 <br />INSURERD: Liberty Insurance Corporation 42404 <br />& conditions <br />INSURER E: <br />INSURER F: <br />- <br />MED EXP (Any one person) $10,000 <br />GUVLKAGtS GCKIII`IGATE NUMBEK: b1UU/2b1J4bt1 REVISION NUMBER! <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested <br />INSR <br />LTR <br />TYPE OF INSURANCE <br />INSD <br />WVD <br />POLICY NUMBER <br />MM/DDIYYYY <br />MMtDDIYYYY <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $2,000,000 <br />CLAIMS -MADE X❑ OCCUR <br />SIR applies per policy terns <br />& conditions <br />$500,000 <br />PREMISES Ea occurrence <br />- <br />MED EXP (Any one person) $10,000 <br />PERSONAL& ADV INJURY $2,000,000 <br />GEN'LAGGREGATE LIMITAPPLIES PER: <br />GENERAL AGGREGATE $4,000,000 <br />POLICY ❑ PRO <br />JECT LOC <br />PRODUCTS - COMP/OPAGG Included <br />OTHER: <br />Professional Liability Included <br />C <br />AUTOMOBILE LIABILITY <br />A52-641-443931-058 <br />08/01/2018 <br />08/01/2019 <br />COMBINED SINGLE LIMIT $ <br />a cci nt 1,000,000 <br />BODILY INJURY ( Per person) <br />X ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />HIREDAUTOS NON -OWNED <br />ONLY AUTOS ONLY <br />BODILY INJURY (Per accident) <br />PROPERTY DAMAGE <br />Per accident) <br />B <br />X <br />UMBRELLALIAB IX <br />OCCUR <br />CSUSA1801997 <br />08/01/2018 <br />08/01/2019 <br />EACH OCCURRENCE $5,000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />AGGREGATE $5,000,000 <br />DED I X RETENTION $25,000 <br />D <br />D <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR! PARTNER /EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />NIA <br />WA764D443931018 <br />AOS <br />wc7641443931048 <br />MN $ WI <br />08/01/2018 <br />08/01/2018 <br />08/01/2019 <br />08/01/2019 <br />XI PER STATUTE I JOTH- <br />ER <br />E.L. EACH ACCIDENT $1,000,000 <br />E.L. DISEASE -EA EMPLOYEE $1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT $1,000,005 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />The city of Santa Ana, its officers, employees, agents, volunteers and representatives are included as Additional Insured in <br />accordance with the policy provisions of the General Liability policy. General Liability policy evidenced herein is Primary <br />and Non-contributory to other insurance available to an Additional Insured, but only in accordance with the policy's <br />provisions. Should General Liability, Automobile Liability and workers' Compensation policies be cancelled before the <br />expiration date thereof, the policy provisions will govern how Notice of Cancellation m y.be delivered to Certificate Holders <br />in accordance with the policy provisions of each policy. <br />REVIEWED BY: EUNICE HEREDIA (PG (OF ) <br />CERTIFICATE HOLDER CANCELLATION <br />01988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />POLICY PROVISIONS. <br />The City of Santa Ana <br />20 civic Center Plaza <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana CA 92701 USA <br />Jv. `fa__ JL <br />01988-2015 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />