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Ac"Rh® CERTIFICATE OF LIABILITY INSURANCE
<br />DATE loonm)
<br />3/8/2018
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T14E 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />USI Colorado, LLC Prof Liab
<br />P.O. Box 7050
<br />Englewood CO 80155
<br />CONTNAM Kathy Kath Star
<br />PHGNE 800-873-8500 FAX
<br />A10 Not
<br />E-MAIL
<br />INSURERS AFFORDING COVERAGE NAIC M
<br />Y
<br />INSURER A:XLSpecialty Insurance Company 37885
<br />6806H441143
<br />INSURED INTERCON35
<br />INSURERB:Travelers Property Cas. Co. of Amer 25674
<br />Interest Consulting Group, Inc.
<br />INSURERC:Travelers Indemnity Co. of America 25666
<br />P.O. Box 18330
<br />Boulder CO 80308
<br />NSURERD:
<br />NSURER E
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 368150016 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.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCEADDL
<br />INSD
<br />SUER
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNYYY
<br />POLICY EXP
<br />MM/DDNYYY
<br />LIMITS
<br />C
<br />X COMMERCIAL GENERAL LIABILITY
<br />Y
<br />Y
<br />6806H441143
<br />11/14/2017
<br />11/14/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />DAMAGE( RENTED
<br />PREMISESSRENTED
<br />) $1,000,000
<br />MED EXP (Any one person) $10,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $2,000,000
<br />X POLICY PEO F7X LOC
<br />PRODUCTS - COMP/OP AGO $2,000,000
<br />$
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />BAOJ093233
<br />11/14/2017
<br />11/14/2018
<br />COMBINED
<br />$1,000,000
<br />-BODIL-V-INJURY(Perpemon)--$
<br />--
<br />AUTOS NED AUTOSULEDBODILY
<br />INJURY(Per accident) $
<br />IxANYAUTO
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />B
<br />X
<br />UMBRELLA LIAR
<br />[I
<br />OCCUR
<br />Y
<br />Y
<br />CUP2F178249
<br />11/14/2017
<br />11/14/2018
<br />EACH OCCURRENCE $4,000,000
<br />AGGREGATE $4,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DEO X RETENTION $0
<br />1 $
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />y
<br />UBBJ034006
<br />11/14/2017
<br />11/14/2018X
<br />PER OTH-
<br />STATUTE ER
<br />ANY UTIVE
<br />E.L. EACH ACCIDENT $1,000,000
<br />REXCLUDEOP
<br />EMBERIPARTNDED? ❑
<br />N/A
<br />E.L. DISEASE - EA EMPLOYEE $1,000,000
<br />InN
<br />(Mantlalary In NH)
<br />(Mandatory
<br />If yes, describe under
<br />DE SCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $1,000,000
<br />A
<br />Professional Liability
<br />Y
<br />DPR9919387
<br />11/14/2017
<br />11/14/2018
<br />Per Claim $2,000,000
<br />Pollution Liability Incl
<br />Annual Aggregate $5,000,000
<br />Claims Made
<br />O ESC RIPTION OF OPERATIONS/ LOCATIONS / VEHICLES IACORD 101, Addltl onal Remarks Schedule, may be attached if more apace Is required)
<br />As required by written contract or written agreement, the following provisions apply subject to the policy terms, conditions, limitations and
<br />exclusions: The Certificate Holder and owner are included as Automatic Additional Insured's for ongoing and completed operations under
<br />General Liability; Designated Insured under Automobile Liability; and Additional Insured's under Umbrella / Excess Liability but only with
<br />respect to liability arising out of the Named Insured work performed on behalf of the certificate holder and owner. The General Liability,
<br />Automobile Liability, Umbrella/Excess insurance applies on a primary and non-contributory basis. A Blanket Waiver of Subrogation applies
<br />for General Liability, Automobile Liability, Umbrella/Excess Liability and Workers Compensation. The Umbrella / Excess Liability policy
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2014101)
<br />"t ,
<br />©1988.2014 ACORD CORPORATION. A rights M se e" y
<br />The ACORD name and logo are registered marks of ACORD
<br />1
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza (M-30)
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO Box 1988
<br />Santa Ana CA 92702-1988
<br />AUTHORIZED REPRESENTATIVE
<br />aYR
<br />ACORD 25 (2014101)
<br />"t ,
<br />©1988.2014 ACORD CORPORATION. A rights M se e" y
<br />The ACORD name and logo are registered marks of ACORD
<br />1
<br />
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