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IBIGROU-01 MMCCARTNEY <br />,44cicwR®" CERTIFICATE OF LIABILITY INSURANCE <br />`--'' <br />DATY) <br />1 1/6/201177 /612 <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. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder In lieu of such endorsements). <br />PRODUCER License # 1780862 <br />CONTACT Certificate Desk <br />HUB International New England <br />299 Ballardvale Street <br />Wilmington, MA 01887 <br />AHDNr o, Eat: 978 657.5100 FAX, Ne:(978) 988-0038 <br />E-MAILAIC <br />s , nee.certificates@hubinternational.com <br />INSUI AFFORDING COVERAGE <br />NAIL # <br />INSURER A: Hartford Underwriters Insurance Company <br />30104 <br />EACH OCCURRENCE <br />INSURED <br />INSURER B: <br />CLAIMS -MADE F7] OCCUR <br />INSURER C : <br />IBI Group <br />INSURER D: <br />18401 Von Karmen Ave. Suite 110 <br />Irvine, CA 92612 <br />INSURER E <br />MED EXP (Any oneperson) <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER' RF_VISION Nr1MPi <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 />IL BR <br />TYPE OF INSURANCE <br />Ary Dp <br />MID <br />POLICYNUMBER <br />POLICY EFF <br />POLICYIYYY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />CLAIMS -MADE F7] OCCUR <br />DAMAGE ETO RENTED S (Ea occurran M <br />$ <br />MED EXP (Any oneperson) <br />IS <br />PERSONAL &ADV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT- APPLIES PER: <br />GENERALAGGREGATE <br />$ <br />POLICY [:]JEpCpT LOC <br />PRODUCTS - COMP/OP AGG <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY Perperson) <br />$ <br />ANY AUTO <br />OWNED SCHEDULED <br />AUTOS ONLY AUTOS <br />BODILY INJURY Per accident <br />$ <br />PaFaCClGent AMAGE <br />$ <br />p <br />AUTOS ONLY AUOTOS 0 <br />UMBRELLA UAB <br />OCCUR <br />EACH OCCURRENCE <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION$ <br />A <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />Wg�anI ER/M%M,EXCLUDED? <br />(mantlstory In ) <br />NIA <br />08WEEL0990 <br />01/13/2017 <br />01/73/2018 <br />PER X OTH- <br />ST U E ER <br />E.L. EACH ACCIDENT <br />11000,000 <br />E.L. DISEASE - EA EMPLOYE <br />1,000,000 <br />$ <br />If yes, describe under <br />DE SCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />1,000,000 <br />$ <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Atldllional Remarks Schedule, may be attached If more space Is required) <br />Endorsement WC000313 Blanket Waiver of Subrogation where required by written Contract, Agreement or Permit, and where permitted by Law. Endorsement <br />WC990394 Blanket Notice of Cancellation to Certificate Holders. <br />Reviewed by: <br />Stop Ga provided in Monopolistic States: NO, OH, WA & WY Digitally signed by Mario Esgindole <br />PP p .1a=Mann Escarole, -Planning end Building Agency, <br />USL&H (All States) where required on=Admlmsnaliva servmes Dmlaion, emelt=measrdmac@earIi <br />Danare, n=us <br />e: 2017 01.19 08:06:11-08'00' <br />SEE ATTACHED ACORD 101 Agreement A-2015-289 <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana <br />20 Civic Center Plaza <br />THE EXPIRATION DATE ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN <br />PO Box 1988 <br />AUTHORIZED REPRESENTATIVE <br />Santa Ana, CA 92702 <br />ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />