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HomeMy WebLinkAboutWITTMAN ENTERPRISES, LLC 7 -201408ANt,� ON H t,'Z- NI{ MAY PRO L�NTiLylip��UIiANC�c. SP nnTE 12--IO-/L% `\ AGREEMENT FOR PROFESSIONAL AMBULANCE BILLING SERVICES BETWEEN THE CITY OF SANTA ANA AND WITTMAN ENTERPRISES, LLC THIS AGREEMENT, made and entered into this 17`r' day of June, 2014 by and between 1 Wittman Enterprises, LLC, a California Limited Liability Company (hereinafter "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and lairs of the State of California (hereinafter "City"). a RECITALS A. The City desires to retain a consultant having special skill in providing ambulance and paramedic billing and collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTs) Programs. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the fi:old„ NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall provide EMS and EMTS billing and collection services as set forth, in Exhibit A, attached to this Agreement and incorporated by reference. At the election of City, and upon written notification by the City Manager or his designee to Consultant, Consultant shall provide paramedic membership subscription services to include: outreach, solicitation, collection, and administration services assetforth in Exhibit B, attached to this Agreement and incorporated by reference. 2. TERM This Agreement shall commence on July 1; 2014 and terminate on Juice 34, 2017, unless 2014, shall be within the Scope of Services of this Agreement. 3. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services a percentage fee of net collections obtained by Consultant per contract year as follows: i, Agreement Year 1 - equal to 6.0 % of net collections obtained by Consultant. ii. Agreement Year 2 - equal to 6.15 % of net collections obtained by Consultant. iii. Agreement Year 3 - equal to 6.3% of net collections obtained by Consultant. b. Consultant shall bill for Emergency_ Medical Services at the rates established by City Council Resolution, c. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing collections received by City, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of perfonnance set forth in the Recitals which may reasonably be expected by City. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided. by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services, Consultant shall pay all salaries and wages; employers social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below; a. Due to the nature of services provided, Commercial General Liability insurance is not required. b. Worker's Compensation Insurance„ In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. t, INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants; special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, nleluding health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Consultant further agrees to indemnify; hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury; damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, andfurther agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care; "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in, rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by facsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of'the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, California 92702-1988 Facsimile (714) 647-6956 Copy to: Executive Director of Finance and Management Services City of Santa Ana 20 Civic Center Plaza (M-17) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647-5414 M City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647-6515 To Consultant: Wittman Enterprises 21 Blue Sky Court Sacramento, California 95828 Facsimile: (800) 906-6552 Courtesy copy to: Jon Riese, Esquire Signature Law Croup 3400 Bradshaw Road, Ste A -4A Sacramento, CA 95827 Facsimile: (916) 290-7616 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by inail, communication shall be effective or deemed to have been given three (3) days after it been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by facsimile; communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. t0. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant; and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant, The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant, nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment; transfer, delegation or subcontract without the City's prior written consent shall be considered null and void, Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions; a. As a condition of such payment, the Executive, Director may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION Consultant shall not discriminate because of race, color; creed, religion, sex, marital status, sexual orientation, age; national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that itis an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be detennined-and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Consultant shall, throughout the tern of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals; waivers, and exemptions, Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto sballbe incorporated as if fully set forth in the body of this Agreement. c. Consultant agrees that, notwithstanding the existence of any dispute between the parties, insofar as possible under the terms of this Agreement, each party will continue to perform the obligations required of it during the continuation of any such dispute, unless enjoined or prohibited by any court, IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: elf . MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: L SA STOR ,K Assistant City Attorney CITY OF SANTA ANA: i DAV CAVAZOS City Manager WITTMAN ENTERPRISES CORRINE WITTMAN-WONG Chief -Executive Officer Tax ID# FEIN # 68-0456021 W44-HIT"n. SCOPE OF SERVICES A. GENERAL PERFORMANCE REQUIREMENTS Consultant shall provide the City of Santa Ana with Billing and Collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS) as specified herein. 1. BILLING Consultant shall prepare all invoices and follow-up mailings. Initial invoicing with both English and Spanish instructions will be on 8x11 billings and will be placed in envelopes, sealed and mailed, postage prepaid. Initial invoicing occurs within three (3) days of receipt of transport ticket. Initial invoicing is fully itemized statement stating all procedures and supplies, 'foil Free $00 telephone number provided to patients. An initial telephone call will also be made at tune of initial invoicing to elicit any insurance information from the patient or patient's family. If Consultant receives no answer on this call, Consultant will send and inquiry tetter in addition to the initial invoice. The standard bill schedule is as follows: 1. Invoice in English and Spanish Immediately 2. Statement 30 days 3, Past Duo 20 days 4. Final Demand 10 days 2. MEDICARE, MEDI-CAL Consultant shall electronically convey all Medicare and Medi -Cal invoices to the appropriate payor. All secondary insurancc, coinsurance and. co -payments for Medicare/Medi-Cal, shall be transferred to the appropriate pay source and promptly billed to that source Consultant shall be responsible for program updates if the requirements of Medicare and Medi -Cal fiscal intermediaries change during the contract period. 3. WORKERS' COMPENSATION AND PRIVATE INSURANCE, Consultant shall bill private insurance, supplemental insurance, secondary insurance and workers compensation in accordance with applicable requirements. Electronic billing of insurance companies is performed where appropriate. Any correspondence for additional information or follow up necessary to secure insurance payment shalt be performed by Consultant. In the event that members of the City's Paramedic Subscription Program have third party insurance, a diligent and timely effort shall be made by the Consultant to identify, bill, and pursue payment from these sources, Medi -Cal, Medicare, and Insurance company billing schedules shall be as needed. 4. DELINQUENT CLAIMS Consultant shall track accounts requiring special handling and follow-up. Consultant will honor City requests for special handling of accounts including but not limited to elderly, handicapped and social dependent situations. Patients with claims aging over 45 days will be contacted by telephone for payment arrangements. Telephone follow up will continue until payment in full is received or account is dismissed by the City to an outside collection agency. Consultant will utilize installment billing as allowed by the City in cases of financial hardship. Accounts will be reviewed monthly so that accounts that have been deemed uncollectable are sent to the City's designated collection agency between 1.80 and 210 days. 5. RECEIPTS PROCESSING Consultant will receive copies of payments deposited by City and post those payments to the correct patient account within one (1) day of receipt, Consultant will forward to City any payments made directly to Consultant. 6. REPORTS Consultant shall perform accurate month end close procedures that will result in the following reports: a. Monthly Ticket Survey b. Monthly Sales Journal c. Monthly Cash Receipts Journal d. Monthly Receivables Aging e. Management Accounts Receivable Analysis f Statistical Reports Reports shall be provided monthly and shall be transmitted electronically in Portable Document Format (PDF) and shall display in portrait page orientation. As deemed desirable by City, alternative reporting content or format may be adopted by mutual agreement of City and Consultant. B. RECORDS Consultant shall maintain records in accordance with generally accepted bookkeeping and accounting practices. Consultant must keep claim submission date, follow-up payments ode on account, source of payment and automatic audit trail to assignment for collection. Consultant agrees that all account files remain the property of the City and will be returned to City at termination of this Agreement. Account file information including patient name, address, age, diagnosis, contact information; billing and payment information shall be updated as necessary to maimain accurate records. Patient records shall be cross referenced by name, Social Security number, address, date of birth, date of service and Paramedic Subscription program membership number. - RECORDS RE`T'ENTION Consultant agrees to -retain all source documents including attachruents for seven (7) yearn All Medicare and Medi -Cal audits for periods during which this contract is in effect shall be referred to Consultant. Consultant shall comply with City established policies, standards and security procedures and procedures relating to the release of information concerning injured or treated parties, C. CITY RESPONSIBILITIES • Submit necessary transport information, including pay source information and patient condition to Consultant for billing purposes + Forward to Consultant all necessary information relating to patient transport services, payments and patient eligibility • Notify Consultant of any accounts requiring special attention/handling Obtain signature of patient or guardian « Provide patient's Social Security number 10 EXHIBIT B OPTIONAL CITY PARAMEDIC SUBSCRIPTION MEMBERSHIP PROGRAM Adoption, promotion, and administration of City's Annual Paramedic Subscription Membership Program: I. As a condition to participation in Optional City Paramedic Subscription Membership Program and to ensure that City is compliant with Medicare guidelines on subscription membership fees; City shall impose a minimum paramedic services subscription fee of not less than $65. 2. The City Manager or his designee shall inform Consultant in writing of City's decision to participate in Optional City Subscription Membership Program. 3. Upon receipt of City's written decision to participate in Optional City Paramedic Subscription Membership Program, Consultant shall assist City in generating and forinattng an initial mass mailer to solicit participation by residents of the City of Santa Ana in the paramedic services subscription membership program. Consultant shall assist City in generating and formatting a renewal paramedic services subscription membership program mailer and will format that mailer for mass mailing. Basic mailer and renewal mailer shall include a multi -color, double -sided City Paramedic Subscription Membership Program solicitation letter/application and return envelope. Use of additional colors, inserts or enclosures may be added at the direction of the City. Consultant's cost shall reflect increased service costs, materials, and postage. Consultant shall prepare a statement of additional costs per mailing piece for approval by the City prior to iincurringg additional costs. 4. Consultant shall generate the City's initial mass mailing list from paramedic billing accounts listed in Consultant's database for fiscal years 2009-10 through 2013-14. Mailing list shall be comprised of all residential paramedic billing accounts in Consultant's billing system. Consultant warrants that the initial mass mailing list will total approximately 20,000 accounts. At the option of the City, alternate mass mailing lists can be developed reflecting shorter time periods. Consultant shall annually send a renewal mailer to all registered. City Paramedic Subscription Membership Program members based on all registered City of Santa Ana subscribers in Consultant's database;. 5. Consultant shall thereafter; on an on-going basis, generate and send an initial paramedic services subscription membership program mailer to all non -subscription paramedic service recipients upon payment or write-off of service recipient's paramedic services billing, 6. Consultant will receive and process each subscription application by adding the member to Consultant's system (profit center) and posting the payment. This database will be used to identify any subscription member that may be transported upon the input to Consultant's billing system. The City will receive separate monthly reports for the subscription program. I 7. Cost—The cost for Consultant's subscription membership program service is as follows: a. Initial and subsequent renewal mailings - $'1.00 per account (to be applied as an offset to Paramedic Subscription Program billing collections). b. Administration of the City's subscription program — 10% of paramedic subscription membership fees collected. i. Agreement Year 1 - 12% of subscription membership fees collected. ii. Agreement Year 2 - I I % of subscription membership fees collected. iii. Agreement Year 3 - 10% of subscription membership fees collected. Participation in the optional City Paramedic Subscription Membership Program shall be elective on the part of the City and can be exercised bythe City Manager or his designee for the first agreement year, prior to January 1, 2015, and thereafter prior to July I" for any subsequent agreement year. 12 Ac"R'H CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE DATE YYI 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 policy(ies) must 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 Wells Fargo Insurance Services USA, Inc.PHONE CA DOI Lic. #OD06408 (916) 589-8000 CONTACT Tracy Dolan 916 589-8153 aIc No 877 611-1971 ADDRESS: tracy.dolan@wellsfargo.com 10940 White Rock Road, 2nd floor INSURER(S) AFFORDING COVERAGE NAIC4 INSURER A: Valley Forge Insurance Company 20508 Rancho Cordova, CA 95670-6076 INSURED INSURER B: National Fire Insurance Company of Hartford 20478 Wittman Enterprises, LLC INSURER C: Continental Casualty Company 20443 PO Box 269110 INSURER D INSURER E: PERSONAL &ADV INJURY $ 2,000,000 Sacramento, CA 95826 INSURER F: COVERAGES CERTIFICATE NUMBER: 7915340 REVISION NUMBER: See below 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 LTH TYPE OF INSURANCE ADDLSUBR JUM WVD POLICY NUMBER POLICY EFF MWDDIYVVV POLICY EXP MMIDDIVVVY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 84034654035 7/1/2014 7/1/2015 EACH OCCUTO EN RRCE $ 2,000,000 DAGE RENTED M PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO JECT LOC PRODUCTS AGG $ 4,000,000 _— $ OTHER: B AUTOMOBILE LIABILITY 84012487490 7/1/2014 7/1/2015 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X _ BODILY INJURY (Par person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Peraooident $ NON -OWNED HIRED AUTOS X AUTOS _ CX UMBRELLA LIAB X OCCUR 84034654083 7/1/2014 7/1/2015 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFIOERIMEMBER EXCLUDED' NIA ---- (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 7" Liability 596476165 07/01/2014 07/01/2015 $1,000,0001$2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) w� Certificate holder named additional insured per attached form. g xC *10 day notice applies if cancelled for non-payment of premium.`,'* ��-- STORCK t ISA E• Attorney Assistant G(tY CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1439 BroadwayTHE ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD @ 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) SB-146932-E (Ed. 06111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifles Insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional Insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED —BLANKET VENDORS WHO IS AN INSURED is amended to Include as an additional insured any person or organization (referred to below as vendor) with whom you agreed, because of a written contract or agreement to provide insurance, but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The Insurance afforded the vendor does not apply to: a. "Bodily Injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement, This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change In the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged In the original container; a. Any failure to make such Inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make In the usual .course of business, In connection with the distribution or sale of the products; f. Demonstration, Installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. "Bodily Injury" or "property damage" arising out of the sole negligence of the vendor for Its SB -146932-E (Ed. 06111) own acts or omisslon or those of its employees or anyone else acting on Its behalf. However, this exclusion does not apply to; (1) The exceptions contained in Subparagraphs d. or f,; or (2) Such Inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, In connection with the distribution or sale of the products. 2. This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering Into, accompanying or containing such products. 3. This provision 2, does not apply to any vendor Included as an Insured by an endorsement Issued by us and made a part of this Policy. 4. This provision 2. does not apply If "bodily Injury" or "property damage" Included wlthin the "products - completed operations hazard" is excluded either by the provisions of the Policy or by endorsement. 2. MISCELLANEOUS ADDITIONAL INSUREDS WHO IS AN INSURED Is amended to Include as an Insured any person or organization (called additional Insured) described In paragraphs 2.a. through 2.h. below whom you are required to add as an additional Insured on this policy under a written contract .or agreement but the written contract or agreement must be: 1. Currently in effect or becoming effective during the term of this policy; and 2, Executed prior to the "bodily Injury," "property damage" or "personal and advertising injury," but Only the following persons or organizations are additional Insureds under this endorsement and coverage provided to such additional Insureds Is limited as provided herein: a. Additional Insured—Your Work That person or organization for whom you do work Is an additional Insured solely for liability Page 1 of 5 due to your negligence specifically resulting from your work for the additional Insured which is the subject of the written contract or written agreement. No coverage applies to liability resulting from the sole negligence of the additional Insured. The Insurance provided to the additional Insured is limited as follows: (1) The Limlts of Insurance applicable to the additional Insured are those specified In the written contract or written agreement or in the Declarations of this policy, whichever Is less. These Limits of Insurance are Inclusive of, and not In addition to, the Limits of Insurance shown In the Declarations, (2) The coverage provided to the additional insured by this endorsement and paragraph F.B, of the definition of "Insured contract" under Liability and Medical Expenses Definitions do not apply to „bodily Injury' or "property damage" arising out of the "products -completed operations hazard" unless required by the written contract or written agreement (3) The insurance provided to the additional Insured does not apply to "bodily Injury," "property damage," or "personal and advertising injury" arising out of the rendering or failure to render any professional services. b. State or Political Subdivisions A state or political subdivision subject to the following provisions: (1) This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit In connection with premises you own, rent, or control end to which this insurance applies; (a) The existence, maintenance, repair, construction, erection, or removal of advertising signs; awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (2) This Insurance applies only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. SB -146932-E (Ed. 06/11) SB -146932-E (Ed. 06/11) This Insurance does not apply to "bodily Injury," "property damage" or "personal and advertising Injury" arising out of operations performed for the state or municlpality. c, Controlling Interest Any persons or organizations with a controlling interest in you but only with respect to their liability arising out of; (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional Insured, d. Managers or Lessors of Premises A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the promises leased to you and subject to the following additional exclusions: This Insurance does not apply to; (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such additional Insured. e. Mortgagee, Assignee or Receiver A mortgagee, assignee or receiver but only with 'respect to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This Insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional Insured. C Owners/Other Interests — Land Is Leased An owner or other Interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This Insurance does not apply to: (1) Any "occurrence" which takes place after you cease to lease that land; or Page 2 of 5 -14693 CAFA S (Ed. 0611 ) (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition operations following; performed by or on behalf of such k. Damage To Property additional insured. Co-owner of Insured Premises "Property damage" to; A co-owner of a premises co -owned by you 1. Property you own, rent or occupy, and covered under this Insurance but only Including any costs or expenses incurred by you, or any other person, with respect to the co-owners liability as co- organization or entity, for repair, owner of such premises. replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such Any person or organization from whom you property for any reason, including prevention of injury to a person or lease equipment. Such person or organization damage to another's property; are insureds only with respect to their liability arising out of the maintenance, operation or 2. Premises you sell, give away or use by you of equipment leased to you by abandon, if the "property damage" such person or organization. A person's or arises out of any part of those organization's status as an Insured under this premises; endorsement ends when their written contract 3. Property loaned to you; or agreement with you for such leased equipment ends. 4. Personal properly In the care, With respect to the Insurance afforded these custody or control of the Insured; additional Insureds, the following additional 5. That particular part of any real exclusions apply: property on which you or any This insurance Boos not apply: contractors or subcontractors working directly or indirectly In your behalf are (1) To any "occurrence" which takes place performing operations, If the "property after the equipment lease expires; or damage" arises out of those (2) To "bodily injury," "property damage" or operations; or "personal and advertising Injury" arising 6, That particular part of any property out of the sole negligence of such that must be restored, repaired or additional insured, replaced because "your work"' was Any insurance provided to an additional Insured incorrectly performed on it. designated under paragraphs b. through h. above Paragraph 2 of this exclusion does not does not apply to "bodily Injury" or "properly apply if the premises are "your work" and damage" Included within the "products -completed were never occupied, rented or held for operations hazard." rental by you. 3. The fciloWng Is added to Paragraph N. of the Paragraphs',3, and 4, of this exclusion BUSINESSOWNERS COMMON POLICY do not apply to "'property damage" (other CONDITIONS: than damage by fire ar explosion) to premises: M. Other Insurance (1) rented to you: A. This insurance is excess over any other Insurance naming the additional insured (2) tornporadly occupied by you with the as an Insured whether primary, excess, permission of the owner, or contingent or on any other basis unless a (3) to the contents of premises rented to written contract or written agreement you for a period of 7 or fewer specifically requires that this Insurance be consecutive days. either primary or ' primary and A separate limit of insurance applies to noncontributing. Damage To Premises Rented To You as 4. LEGAL LIABILITY— DAMAGE TO PREMISES described In Section D — Liability and A. Under B. Exclusions, 1. Applicable to Medical Expenses Limits of insurance. Business Liability Coverage, Exclusion k. SB -146932-E Page 3 of 5 (Ed. 06111) Paragraphs 3, 4, 5, and 6 of this exclusion do not apply to liablilty assumed under a sidetrack agreement, Paragraph 6 of this exclusion does not apply to "property damage" Included In the "products -completed operations hazard." B. Under B. Exclusions, 1. Applicable to Business Liability Coverage, the last paragraph of 2, Exclusions is deleted and replaced by the following: Exclusions c, d, a, f, g, h, 1, k, 1, m, n, and o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner or to the contents of premises rented to you for a period of 7 or fewer consecutive, days. A separate limit of Insurance applies to this coverage as described in Section D. Liability And Medical Expenses Limits Of Insurance. C. The first Paragraph under Item 5. Damage To Premises Rented To You Limit of Section D. Liability And Medical Expenses Limits Of insurance is replaced by the following: The most we will pay under Business Liability for damages because of "property damage" to any one premises, while rented to you, or temporarily occupied by you, with the permission of the owner, including contents of such premises rented to you for a period of 7 or fewer consecutive days, is the Damage to Promises Ranted to You limit shown In the Declaration. 5. Blanket Waiver of Subrogation We waive any right of recovery we may have against; a. Any person or organization with whom you have a written contract that requires such a waiver. 6. Broad Knowledge of Occurrence The following items are added to E. Businessowners General Liability Conditions in the Businessowners Liability Coverage Form, a. Paragraphs a. and b, apply to you or to any additional insured only when such "occurrence," offense, claim or "sulP is known to: (1) You or any additional insured that is an Individual; SB -146932-c (Ed. 06111) 8B -146932-E (Ed. 06191) (2) Any partner, If you or an additional Insured Is a partnership; (3) Any manager, if you or an additional Insured Is a limited Ilabillty company; (4) Any "executive officer" or insurance manager, If you or an additional insured Is a corporation; (5) Any trustee, If you or an additional Insured Is a trust; or (6) Any elected or appointed official, if you or an additional Insured Is a political subdivision or public entity. This paragraph a, applies separately to you and any additional Insured. 7. Bodily injury Section F. Liability and Medical Expenses Definitions, Item 3, "Bodily Injury" is deleted and replaced with the following: "Bodily injury" moans bodily injury, sickness or disease sustained by a person, Including death, humiliation, shock, mental anguish or mental Injury by that person at any time which results as a consequence of the bodily injury, sickness or disease. 8, Expanded Personal and Advertising Injury Definition a. The following is added to Section F. Liability and Medical Expenses Definitions, item 14. Personal and Advertising Injury, In the Businessowners General Liability Coverage Form; h. Discrimination or humiliation that results in Injury to the feelings or reputation of a natural person, but only If such discrimination or humiliation Is: 1. Not done intentionally by or at the direction of: a. The Insured; or b. Any "executive officer," director, stockholder, partner, member or manager (If you are a limited liability company) of the insured; and 2. Not directly or indirectly related to the employment, prospective employment, past employment or termination of employment of any person or person by any Insured. b. The following is added to Exclusions, Section B,: Page 4 of 5 : (15)Dlscrimination Relating to , Room, Dwelling or Premises Caused by discrimination directly or Indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sublease of any room, dwelling or premises by or at the direction of any Insured. (16) Fines or Penalties Flees or penalties levied or Imposed by a governmental entity because of discrimination. c. This provision (Expanded Personal and Advertising Injury) does not apply If SS -146932-E (Ed. 06/11) SB -146932-E (Ed, 66/11) Personal and Advertising injury Liability Is excluded either by the provisions of the Policy or by endorsement. 9. Personal and Advertising Injury Ro-doflned Section F. Liability and Medical Expenses Definitions, Item 14, Personal Advertising Injury, Paragraph c. Is replaced by the following: c. The wrongful ovlct[on from, wrongful entry Into, or Invasion of the right of private occupancy of a room dwelling or premises that a person or organization occupies committed by or on behalf of We owner, landlord or lessor, Page 5 of 5 WITTENT•01 AGIMROTH AC-"RLY CERTIFICATE OF LIABILITY INSURANCE OqT/27/2014 v) 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. 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 policy(fes) must 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 CONTACT NAME: Western Elie Insurance Solutions ____...—_._.._..._ . PHONE ......... ..------- 910 259.0000 (666) 206'$646 ) P.O. Box 2980 1A/C No Exq;� INC Nal:: Rocklin, CA 95677 AD RESS: ADDRE INSURER(S) AFFORDING COVERAGE__________ NAICIf _ __ INSURER A_: Granite State Insurance 23809 INSURED INSURER S: ., Wittman Enterprises LLC INSURER C INSURER D: PO Box 269110 Sacramento, CA 95026 $ _ EINSU_RER_E: INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADU SUS POLICY NUMBER Err PMIOgY YYY 4MMLI OY YXY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE E]OCCUR PREM ISESSEaoceurrencp1_- MED EXP (Any one person) $ PERSONAL &ADV INJURY___ S AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ GEWL POLICY u PRO-JECT LOC l PRODUCTS � COMP/OP AGG S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S BODILY INJURY (Per person) S ANY AUTO ALL OWNED SCHEDULED----- AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE „(Pef, accident)_,,,,_„_,,,,,,,_ UMBRELLA ILIAD OCCUR EACH OCCURRENCE _._............... 5 _.._.... ... EXCESS WAS CLAIMS -MADE AGGREGATE ...... ...._---- __ $ DED RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y� OFFICEREMBER EXCLUDED? /M (Mandatory In NH) Nra WC065256372 07/01/2014 07/01/2015 x PER OTH- STATUTE ER_,_,_„__ _ E.L. EACH ACCIDENT $ 1,000,000 —""'-'"""-'—--"""""""-..... EA. DISEASE - EA EMPLOYE $ 11000,000 Ues, deralbe under SCRPi'ION Or OPERATIONS bele, E.L. DISEASE - POLICY LIMIT $ 1,000,000 Q to® DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)$�� qp tNO'N Gt YOP�o ney $lyta CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) ©1900.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cit of Santa Ana Y 20 Civic Center Piz. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZEDREPRESENTATIVEl ]fn{A\jt 4 v �w Y `V ACORD 25 (2014101) ©1900.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD WITTENT•01 AGIMROTH CERTIFICATE OF LIABILITY INSURANCE DATE (MMYI o14 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: It the certificate holder is an ADDITIONAL INSURED, the palicy(les) must 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 Ileo of such ondorsement(s). PRODUCER Western Elhe Insurance Solutions P.O. Box 2969 Rocklin, CA 95677 CON A NAME: RHONE e.t (916) 259-6900 p°1c N.I: $66) 206•$646 EMAIL ADDRESS: INSURERS APPORDING COVERAGE NAICR INSURERA: Granite State Insurance 28$09 INSURED Wittman Enterprises LLC PO Box 269110 Sacramento, CA 95826 INSURER B: INSURERC: INSURER D INSURERS: INSURER P: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW VE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITU OF ANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR L TYPE Of INSURANCE AVULIbUM POLICYNUMHER MMMD1YVYY MMLONYYV D LIMITS COMMERCIAL GENERAL LIABILITY CLAIMI ❑ CCCUR $ EACH OCCURRENCEENTED PREMISES En occurrence $ MED EXP (Any one parson $ PERSONAL&ADV INJURY $ GEWL AGGREGATE LIMIT APPLIES PER POLICY [:] TG`T 7LOC OTHERN,N GENERAL AGGREGATE $ PRODUCTS -CONINOP AGO $ $ AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED CHO6 LED NON OWNED HIREDAUTOS AUTOS 2e.Bw%Eni L MIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Peraoa-PTMFFl- nl MA E $ UMBRELLA LAB EXCESS LIAR OCCUR CDUMS-MADE I$ EACH OCCURRENCE $ AGGREGATE $ CEO I I RETENTION$ I A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEPIEXEC TIVE YIN OFFICERIMEMRER EXCLUDED? (Mendalory In NH) (yyS dese be Under DF4(:RIPTION OFD F_RATION3 Glow NIA 0065256372 07101/2014 07101/2015 X 3'fATOTE ER _ E.LEACHACCIDENT $ 1,000,000 E.L, DISEASE - EAEMPLOYEF $ 1,000,000 F.L.dSEASE-POLICY LIMIT $_ 1,000,0D0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddlUonel Remarks Schedule, maybe a bwmdHrrwra spaaclaraqulrad) app�0�l� ► I /z��> L� ILew gal o �, ,� o The Clty of Santa Ana 1438 S. Braodway Santa Ana, CA 927117 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED ACORD 25 (2094/01) The ACORD name and ID90 are registered marks of ACORD 250112 A r� 1 ® A10...aJr1 /-1 CERT9 FICATE OF LIABILIII'Y INSURANCE ­OATE 6/30/2014 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 certlNcatD holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 15 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 t0 the certificate holder In Ileu of such endorsement(s). PRODUCER Wells Fargo Insurance Services USA, Ind, CA 001 LID. #DD08408 (916) 589.8000 -10940 White Rock Road, 2nd floor Rancho Cordova, CA 95670-6076 N CUJACT Tracy Dolan _ PHONE 916589-8153 FAX, 877 611-1971 1.°t 0' ArcNs) �----------- MAIL A�OR�Sa; _tracy,doanQwelsfargo.Com INSURER(S) AFFORDING COVERAGE NAI" _INSURER A; Valley Forge Insurance Company 20508 INSURED Wittman Enterprises, LLC PO Box 269110 Sa cramonto, CA 95826 INSURER BNational Fire Insurance Company of Hartford 20476 INSURER I Continental Casualty Company 20443 INSURER D : 5 2,000,000 _ INSURERS: $ 300,000 INSURER P ; $ 10,000 nnvcnun_cc Y:CRTIFIr-ATP NIIMPl 791534U REVISION NUMBER: BOB below v THIS IS TO CERTIFY THAT THE 0LIC158 OF INSURANCE LISTED 85LOW 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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEDBYPAID CLAIMS. INSR LTR TYPE OF INSURANCE _ DOC POLICY NUMBER SFPOLICYY17 POI ICYYYYY LIMITS A X COMMERCIAL OENERALLIASILITY CLAIMS-MADEEXI OCCUR 84034864035 7/1/2014 7/1/2015EACH OCCURRENCE 5 2,000,000 PREMIS9211 400 r� 1 $ 300,000 MED EXP (Any one person $ 10,000 PERSONAL A ADV INJURY S 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS _COMPIOP AOG $ 4,000,000 X POLICY [ JEC LOC _ $ OTHER: AUTOMOBILE LIABILITY B40124B7490 7/1/2014 711/2015 COMBINED SINGLE LIMIT $ 1.000,000B BODILY INJURY (Per person) _X - ANYAUTO BODILY INJURY (Per aooldenl) $ ALL OWNED SCHEDULED AUTOS __ AUTOS NON-OWNED X HIRED AUTOS x AUTOS PRO PER TY DAMAGE er 9cldent -- $ $__ G, x UMBRELLALIAB X OCCUR 84034664083 7/1/2014 7/1/2015 EACH OCCURRENCE $ AGGREGATE W_2,000,000 z,000,000 __ $ EXCESS LIAO CAMS MADE __ DED x NTION$ 10,000 RETE S WORKERS COMPENSATION AND EMPLOYER5'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE El OFFICERIMEMaER EXCLUDED? (Mandalary In NH) NIA PER Thl- STATUTEER E.L. EACH ACCIDENT_ E.L. DISEASE: EA EMPLOYEE $ E.L, DISEASE -POLICY LIMIT _ S fps desoribe under DESCRIPTION OF OPERATIONS below „_ C Prof Liability 596A78165 07/U1/2014 07/01/2015 $t,000,000rS2,00oA0o DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLE5 (ACORD 101, Additional Ramar6%Schedule, Indy be sdachad If mom %page Is mgalmd) Corllticate holder named additional insured per attachad form. "10 day notice applies If cancelled for non-payment of premium. 6 et 7 �7 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1439 Broadway ACCORDANCE WITH THE POLICY PROVISIONS, Santa Ana, CA 92701 AUTBORI2ED REPRESENTATIVE Tho hd.00h name and Indo ara maistered marks of ACORD © 1988.2014 ACORD CORPORATION. All rights reserve ACORD 25 (2014101) IIII IIIIIIIII II IIIA IIIIIIIII fillIIIINIIIIIIN '❑YmnMGM0020ROM7000W $B-146932�E (Edi 06111) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. # r r This andorsament modifies Inauranoa provided under the folbwing: BUSINESSOWNER3 LIABILITY COVERAGE FORM Coverogs afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED- BLANKET VENDORS own acts or omisalon or those of Its employees or anyone also aoting on Its WHO IS AN INSURED Is amended to Include as, an behalf. However, this exclusion does not additional Insured any person or organization (referred apply to; to below as vendor) with whom you agreed, because of a written contract or agreement to provide Insurance, but only with respect to 'bodilyInjury" or "property darnago" arising out of"your prodcts" which are distributed or sold in the regular course of the vandor's business, subject to the following additional exclusions: 1, The Insuranoe afforded the vendor does not apply to: a. "Bodily Injury" or 'property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability In a contract er agreement, This exoluslon does not apply to liability for damages that the vendor would have In the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physloal or chemical change in the product made Intentionally by the vendor; d, Repackaging, except when unpacked solely for the purpose of Inspection, demonstration, testing, or the substitution of parts under instruotlons from the manufacturer, and then repackaged In the original container; a. Any failure to make such Inspections, adjustments, tests or servicing as the vendor has agreed W make or normally undertakes to make In the usual ,course of business, In connection with the distribution or sale of the products; f. Demonstration, Installation, servicing or repair operations, except such operations performed at the vendor's promises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substanoo by or for the vendor; or h, "Bodily Injury" or "property damage" arising out of the sole negligence of the vendor for Its 66.148832-5 (Co. 06111) (1) The exceptions contained in 5ubperagrapha d. or f,; or (2) such inspoctfons, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make In the usual course of business, in connection with the distribution or sale of the products. 2. This Insurance does not apply to any Insured person or organization, from whom you have acquired such products, or any Ingredient, part or contalner, entering Into, accompanying or containing such products. 3. Thispprovision 2, dose not apply to any vendor included as an insured by an endorsement Issued by us and made a part of this Policy. 4. This provision 2, does not apply if "bodily injury" or "property damage" Included wlthln,the "produrts- compieted oporattons hazard" Is excluded alther by the provisions of the Policy or by endorsement, REEHEH9 NIF112l *2r 3i r ti�TSf_irifdfli>[{ . WHO IS AN INSURED Is amended to Include as an Insured any person or organization (called additional Insured) described In paragraphs 2.0, through 2,b, below whomyou are required to add as an additional Insured on this policy under a written contract .or agreement but the written contract or agreement must be; 1. Currently In affect or becoming effective during the term of this policy; and 2. Executed prior to the "bodily Injury," "proparty damage" or "personal and advertising Injury,"hut Only the following parsons or organizations are additional Insureds under this endorsement and coverage provided to such additional Insureds Is limited as provided herein: a, Addltlonallnsured — Your Work That person or organization for whom you do work fa an additional Insured solely for liability flags 1 of H Af o/ � 1 "CYB"1P3"N"il"e"1"YNpNroIaPo' due to your negllgenpe specifically resulting from your work for the additional insured which is the subject of the written contract or written agreement, No coverage applies to !lability resulting from the note negligence of the additional Insured, The insurance- provided to the additional Insured Is limited no follower (1) The Limits of Insurance applicable to the additional Insured are those speckled In the written contract or written agreement or in the Doctarations of this policy, whichever Is less. 'these Limits of Insurance are inclusive of, and not In addition to, the Limits of insuradoe shown In the Deolaratlona, (2) The coverage provided to the additional insuredby this endorsement and paragraph F.3, of the deflnitkrn of 'Insured contract" under Liability and Medical Expenses Definitions do not apply to "badly Injury" or "property damage" arlaing out of the "produots-oompiated operations hazard" unless required by the written contract or written agreement. (3) The Insurance provided to the additional Insured does not apply to "bodily injury," "property damage," or "porsonal end advertising Injury" arising out of the rendering or failure to render any professional services. b. Stake or Political Subdivislons A state or political subdivision subject to the following provisions: (1) This Insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit In connection with promises you own, rent, or control and to which this insurance applies: (a) The exlstonce, maintenance, repair, construction, erection, or removal of advertising signs; awnings, canopies, caller entrances, coal holes, driveways, manholes, marquees, horataway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (2) This Insuranceapppliea only with respect to operations parfcnned by you or on your behalf for which the state or polltloal subdivision Iles Issued a permit, Sia -146N2 -E (Fd. Owl 1) SS -146932•E (Ed. a61t1) This Inawanoo does not apply to "bodily Injury" "property damage" or "personal and advertising injury" arising out of operations performed for the state or muntolpallty. o. Controlling Interest Any persona or organizations with a controlling interest in you but only with respect to their liability arising out of. (1) Their flnanclol control of you; or (2) promises they own, maintain or control who$ you lease or occupy these promises. This Insurance does not apply to structural alterations, now construction and demolition operations performed by or for such additional Insured. d. Managers or Lessors of Promises A manager or lessor of premises but only with respect to liability arleln® out of the ownership, malntonanca or use of that specific part of the premises leased to you and subject to the foltowing additional exclusions; This Insurance does not apply to. (1) Any "occurrance" which takes place after you cease to be a tenant In that promises; or (2) Structural alteratlons, now construction or demolition operations performed by or on behalf of such additional Insured. a, Mortgages, Assignee or Receiver A mortgagee, asatgnee or receiver but only with Tespeot to their liability as mortgagee, assignee, or receiver and arising out of the ownership, maintenance, or use of a premises by you. This Insurance does not apply to structural alterations, naw construction or demolition operations performed by or for such additional Insured. f, Ownersl0ther Interests — Land Is Leased An owner or other interest from whom land has been leased by you but only with respect to [lability arfsfng out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the fcliowing additional exclusions. THs Insurance does not apply to (1) Any "oocurrenoe" which takes place after you cease to lease that land; or r „r- (�� Pada. of6 �, k�)r 'P�"'y"'cZf r r� i/di d F .7 vos"o 111iI11111111gill i111111IIIII!1111111IIIIN11111111 •"Y"",N^0/00"B2M9roMMNI Q A s (Ea oft (2) Structural alterations, now Damage To Property, Is roplaoad by the construction or demolition Operations following; performed by or on behalf of such k, Damage To Property additional insured. g.. Co-owner of Insured Premises "Property damage" to: A co-owner of a promises co -owned by you 1• Property you own, rent or occupy, including any costs or expenses and covered under thls Insurance but only with respect to the co-owners liability as co- Incurred by you, or any other parson, owner of such premises. organization or entity, for repair, replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such Any person or organization from whom you property for any reason, Including prevention of Injury to a person or lease equipment. Such parson or organization damage to another's property; are Insureds only with respect to their liability arising out of the maintenance, operation or 2. Premises you 8011, give sway or use by you of equipment leased to you by abandon, If the "property damage" such person or organization. A person's or arises out of any part of those organization's status as an Insured under this premises; endorsement ends when their written contract 3, Property loaned in you; or agreement with you for such leased equipment ends. 4. Personal property In the care, VVM respect to the Insurance afforded these Custody or control of the Insured; additional Insureds, the following addilional B. That particular part of any real exclusions apply; property on which you or any This Insurance does not apply: contractors or aubconlractora working dlrecdy or indirectly in your behalf are (1) To any "occurrence" which takes piaos performing operations, If the "properly after the equipment lease expires; or damage" arises out of those (2) To "bodily Injury," "property damage" or operations; or 'personal and advertising trJurlil arising 6. That particular part of any property out of the sole negligence of such that must be restored, repaired or additional Insured. replaced because "your work" woe Any insurance provided to an additional insured incorrectly performed on it. designated under paragraphs b. through In. above Paragraph 2 of this exclusion does not does not apply to "bocilly Injury" or "property apply If the promises are "your work" and damage" Included within the "producta-completsd were never occupied, rented or hold for operations hazard." rental by you. 3. The following Is added to Paragraph H. of theParagraphs 1, 3, and 4, of this exclusion BUSINESSOWNEliB COMMON POLICY do not apply to "property demage" (other CONDITIONS; than damage by fire ar explosion) to promisee: H. Other insurance (1) rented to you: 4. This Insurance to excess over any other insurance naming the additional Insured (2) temporarily occupied by you with the as an Insured whether primary, excess, permission of the owner, or contingent or on any other 6asie un leas a (3) to the contents of premises rented to written contract or written agreement you for a period of 7 or fewer specifically requires that this insurance be consecutive days, either primary or ' primary and A separate limit of Insurance applies to noncontributing. Damage To Premises Rented To You as 4. LEGAL LIABILITY— DAMAGE TO PREMISES described in Section D — Liability and A. Under B. Exclusions, 1. Applicable to Medical Expenses Limits of Insurance, Business liability Coverage, Exclusion k. ^ 1 5B 146932-E (Ed, 06/11) J^ ✓3 ,' c Page o C, v+`eoc 1517 n 151 SB446932•E CAM (Ed. 08171) paragraphs 3, 4, 8, and 8 of this (2) Any partner, it you or an addlllonal exclusion do not apply to liability Insured Is a pertnsrship; assumed under a sidetrack agreement, (3) Any manager, if you or an additional Paragraph 6 of this exclusion does not Insured Is a limited IlabVIty company; apply to "property damage" included In (4) Any "executive officer" or Insurance the produote-completed operations manager, If you or an addltional Insured Is hazard," a corporation; B. Under B. Exclusions, 1, Applicable to (6) Any trustee, if you or an additional Business Liability Coverage, the last insured Is a trust; or paragraph of 2. Exclusions Is deleted and rsplaoad by the following; (8) Any el acted or appointed official, If you or Exclusions 4, d, a, f, g, N, I, k, I, m, n, and o, on additlonal Insured Is a P0131001 subdivision or public entity, do not apply to damage by fire to promise® While rented to you or temporarily occupied by This paragraph d, applies separately to you you with permission of the owner or to the and any additional Insured. contents of promiaos rented to you for a 7 Bodily Injury period of 7 or fewer consecutive. days, A separate limit of Insurance applies to this Section R Liability and Medical Expenses coverage as descrlbed in Section D. Liability Daflnitions, Item 3. "Bodily injury" is deleted and And Medical Expenses Limits Of replaced with the following: Insurance. "Bodily lnjury" means bodily Injury, sickness or C. Ther first Paragraph under Item 8, Damage To disease sustained by a person, Including death, Promises Rented To You Limit of Section humiliation, shook, mental anguish or mantel D. Liability And Medical Expenaas Limits injury by that person at any time which results as Of insurance Is replaced by the following: a consequence of the bodily Injury, sickness or The most wa will pay under Business Liability disease. for damages because of "property damage" 8, Expanded Personal and Advertising Injury to any one promises, while ranted to you, or Definition temporarily occupied by you, with the permission of tha owner, including contents o} a, The following Is added to Section F, Liability such promises ranted to you fora parted of 7 and Mllowin Expenses bSectio na, item 14, Personal and Advertising Injury, in the days, Is the Damage to or fewer Rented Premises Itantad to You limit shown to the Businassowners General Liability Declaration. Covbrago Form, 8. Blanket Waiver of Subrogation h. Disoviminatlon or humiliation that results in Injury to the feeltngs or reputotlon of a natural We waive any right of recovery we may have pparson, but only If suoh discrimination or against, humlllatlon Is: a. Any person or organization with whom you 1. Not done Intentionally by or at the have a written contract that requires such a direction of; waiver. a. The Insured; or e, Broad Knowledge of Occurrence b. Any "exaoutive officer," director, The following items are added to E, stockholder, partner, member or Businossowners Goneraf Liability Conditlons manager (If you are a limited liability in the susinoasowners Liabltity Coverage company) of (he Insured; and Form: 2. Not directly or Indirectly related to the a, Paragraphs a, and b. apply to you or to any employment, prospective employment, additional insured only when such past employment or termination of "occurronoo," offense, claim or "suit" is known employment of any person or person by to: any Insured. (1) You or any additional Insured that Is an b. The following is added to Excluslons, Section Individual; B.: SB•146932-E Page 4,of 6 (Ed. fr�P & IIIiIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIiiIIIIIIIIIIIIII •cv"mn�,mo""zom"m =1 (16)Dlsorimination Relating to Room, Dwelling or Promises caused by dlacrimination directly or Indirectly related to the sale, rental, Was or sub -lease or prespootivo sale, rental, lease or sub -lease of any room, dwelling _ or premises by or at the direodon of any Insured, (16) Fines or Penalties Pines or penalties levied or Imposed by a governmantai entity because of discrimination, c. This provision (Expanded Personal and Advertising Injury) does not apply If SR -146982-E (Fd. 06111) 8B -146982•E (Ed, 96111) Personal and Advertising Injury Ltablllty Is excluded olther by the provisions of the Palley or by endorsement. Personal and Advertising Injury Ro-deflnad Saotlon F. Liability and Medical Expenses Definitions, Item 14, Personal Advertising Injury, Paragraph c. is replaced by the following: o, The wrongful evlotion from, wrongful entry Into, or Invasion of the right of private occupancy of a room dwellingg or promises that a person or organization occuplos committed by or on behalf of Ito owner, landlord or lesaor, fc-p V1 jr Gr Page 5 of 5 ou, IIIIIII I lil I III III11111111111111 1EI 111111111111111111111111111111 III "CVB01A801D0D03019)NigIpW10' A - zo 1'/ - / L/,5 WITTENT-01 AGIMROTH DATE (MWOONYYY) CERTIFICATE OF LIABILITY INSURANCE F6/2712014 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, EXT15N'O OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOE'S 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 be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsoment(s). PRODUCER CONTACT' NAME: Western Elite Insurance Solutions P.O,. Box 2980 Rocklin, CA 95677 PHONE-- - ("FAX _ C, (�I�,,_Px0 (916) 259-6900 (AIC, Nc,I (866) 206.8546 ADDRESS; INSURER(S) AFFORDING COVERAGE NATO COMMERCIAL GENERAL, LIAMLITY INSURER A: Granite State Insurance 28809 INSURED INWRER B; IN$URERC Wittman Enterprises LLC INSURER A PCI 130X 269116 Sacramento, CA 95826 INSURER E : INSURER F nnVFRAnFR CERTIFICATE NUMBER- REVISION NUMBER! THIS IS TO CERTIFY THAT THE (POLICIES OF INSURANCE LISTED BELOW VE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITU OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E 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, (L TR TYPE OF INSURANCE ADDL... '. PdLICYNUh7USR POLICY EFF MMIOAf1iYYY POLICY EXP ' M11M1idfOOd1'YYY. LIMITS COMMERCIAL GENERAL, LIAMLITY EACH OCCURRENCE $ CLAIM$-NMADE D OCCUR ICiAMFaGE 1'iS"IENI'E6— .-__--- PREMISES Ea oscarrenae $ MED EXP (Any once person) S PERSONAL 8 ADV INJURY S GEN"L AGGREGATE LIMIT APPLIES P -It GENERAL. AGGREGATE .$ POLICY ❑PRC- LOC YECT PRODUC"IiS-COMP/OPAGG 5 $ t77kIF4�, AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $. ANY AUTO BODILY INJURY (Per person) $ ALL DOWNED SCHPUUl.d' D AUTOS AUTOS HIREDAUTOS AUTOSM1;rNED AUTOS ..BODILY INJURY (Per acoidonl) S ROPPara adar1lDAMAGE MA P $ UMBRELLA LIAB CCCUR EACH OCCURRENCE. AGGREGATE $ EXCESSLIAB 'CLAIMS•MAOE _ _ DED Rr-.TENTION$ $ Int WORKERS COiAPEN'SATION AND EMPLOYERS" LIABILITY' ANY PROPMPTO JPARTNEP�EXECUTRVE Y OFFICEWMEMBER EXCLUDED?El (Mandalory irl NH) NIA' x;065250372 07/0"1120141 07101120/5 PER '1" - STATUTE,: ER E.L. EACH ACCIDENT $ 1,000,000 E.L.DISEASE -LA.E-MPLOYL $ 1,000,0010 If yes, daecrlue under rIF4f'I'tIP7"1<]NOP QPFRATION.9';Jio,v Pl. DISEASE - POLI CYLIhdI'T $ 1.,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks SchedWa, maybe attacha d if more space de requtrod) C The Clty of Santa Ana 1439 S, Braodway Santa Ana, CA 92707 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISI'ON'S. AUTHORIZED' REPRESENTATIVE b 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 260112 CERTIFICATE OF LIABILITY INSURANCE DATE (MMODNYYYI 1/112015 THISCERTIFICATE IS ISSUED AS A MATTER OF INFORI4IATION 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 a'lk A93 D1TIONAL INSURED, the pollcy(ies) must be endorsed, if SUBROI9ATION IS WAIVED, subject to the terms and conditions of the Polley, certain policies may require an endorsement. A statement on this certificate does not conferrights to the certificate holder In lieu of such endorsement(s). tJAME:OT Trarl Williams PRODUCER P}IONE 8774437193 c.Na.E 11.916589-8170—_.._.NC ®L. 4Vells Fargo Insurance ServlOes U3A, Inc. mrstiaLEss:. traci.d.Wlliams+g,w&llsfargO.com �. 10940 White Rock road, 2nd Floor INSU,APFORDING cauRAc—.. NAtcx__ .'�". 20548 Rancho Cordova, GA 95670 INSURER A , Valloy Forge Insurance Company �_8... J —NsuRa National Fire Insurance Company of Hartford 20478 INSURED 20443 .... Wittman Enterprises, LLC INSUREPoc: Continental Casualty Company �._ PO Box 265110 INSURER D :. — Sacramento, CA 95826Inaerd� COVERAGES THIS RS TO CERTIFY THAT THE POL G ESTOFI INSURANCE LIS I LU BELOW HAVE BEEN ISSUED TO THE INSURED CATE NUMBER: 8616165 ENAMED ABOVE VISION N SFOR THE POLICY PERIOD lor)ICATED. 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. _ rA ADDLE DR paLICYEFF PC LICDYEXP LIMITS TYPE, OF INSURANCE POLICY NUMBEREACH { G lRRENCES 2001000 COMMERCIAL GENERAL UABILITY X 184034654035 7/112014 711/2415 300,900 E -W-1 PREMISES Eaaneurr®ncti CLAIMS -NAIL L..--IOCCUR 10.000 _ NED ExP Any ane pa ser) $ .. -.-� PERSON ALAADV INJURY 8.. 2,000,000 GENERAL AGGREGATE $ 4,000,000 GFal- AGGREGATE LIMIT APPLIES PER: 4,000,000 X POLICY L.00 PRODUCTS - CaMPIOP AGG _ �. C. p cOT S OTHER: - GoM01 ED T E M T $ 1,000,0W B AUTOMOBILE LIABILITY 84012487490 7/112014 71112015-aagdd,,ntl BODILY INJURY (Par Parsnn) $ x ANY AUTO? '. ALL AUTO EXOCCUR LED BODILY INJURY (Per acddwl $ AUTO$ PROPERTY DAM E $ X ..OMT _ Para 'dent - HIRED AUT $ IB4ij346f1$3.. 711/2414 71112415 EACH OCCURFtENGE S 2..000,000 PL UMBRELLA LIARR AGGREGATEEXCESS LIS-MADEDED X"10,000 WORKERS COMSTnru - �R AND EMPLOYERS' LIABILITY Y)Ni F.L. EAC HACCIDENT�S ANY PROPRIETC WPARTNERJe•=XECUTIV€ N l A F. u� . OFFECERIMEMBER EXCLUDED? F..L. DISCASE - EA EMPLOYE ` $. (Mandatory In NH) Mee, describe under E.L. DISEASE -POLICY LIMIT $ SGRIPTION OF� OPERATIONS below 596476165 0710112014 0710112015 $1,00%00012,000,009 C Prof Liabllty DESCRIPTION OF OPERATIONS rLOGA71ONS I VEHICLES (ACORD 101, Addlitonal Remarks Schadule, m%Y heattached If more apace la re9ulredl SEI -146932-'E (Ed. 46111) Certificate holder named additional Insured per attached form. E 01 21 -7 CERTIFICATE HOLDER 4."- CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa, Ana THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN. 20 Civic Center Plllza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE 9e The ACORD name and logo are registered marks. of ACORD 0 1988-2014 ACOIRD CORPORATION. All rights reserved. ACORD 25 (2014101) ITtu ea�eaa�te rcpiaccs gaillriG3lt�'T9rflJ®Irowad m rd;10r2r�1A1 POLTGY NUMBER: 84034654035 813-1415932-E CNA (Ed. 06111) THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT -CAREFULLY, 131—ANKET ADDITIONAL INSURED — LIABILITY EXTENSION This endorsement modifies insurance provided tinder the follovAng: BUSI N EsSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional Insured on any other endorsement now or hereafter attached to this Policy, tk ba Af Its 1, ADDITIONAL INSURED — BLANKET VENPOR8 WHO IS AN INSURED Is airanded to Include as an ad ditiona) Insured any person or orgainIzAtion (referred to below as vendor) with whom you agreed, because of a , written contract or agreement to provide insurance, but only with respect to 'bodily injury" or "property damage" arising out of "your products" which are djstributed or sold In the regular oourhe of 1he vondoes business, subject to the following additional exciuslons: 1. The Insurance afforded the vendor does not apply to: it. "Bodily Injury' or "property damage" for which the vendor Is obIlUated to pay damages by reason of the assumption of liability In a contact 6r agreennotiL This excluslon does not apply to liability for damages that the vendor would have In the absence Of the contract or agreement; h.' Any express warranty unauthorized by you; c. Any physical or chemical change In the product made Intentionally by the vendor; omissionI own acts or omission or V employees or anyone, else acting on Its behalf. However, this exclusion does not apply to; (1) The exceptions contained In Subparagraphs d, or f.; or (2) Such [nepectlons, adjustments, toots or servicing as the vendor has agreed to make or normally undertakes to make In the usual course of business, In conneollon with the distribution or sale of the products. 2, This Insurance does not apply to any Insured person or organization, from whom YOU have acquired such products,, or any Ingredient, part or container, entering Into, accompanying . or c rii, such products. ontain rig 3. This provision 1 does not apply to any vendor Included as an Insured by an endorsement Issued by 'its and made a part of this P0110Y, 4, This provision 2, does not apply If "bodily NutY' Or "property damage" Included within ' the "products - completed operations hazard" Is excluded either d. RepaokagIng.,eXoeP1 when unpacked solely by the provisions of the Policy or by endorsement, for the purpose of inspection, demonstration, testing, or the slibstItutiOn Of parts under MISCELLANEOUS, DDITIONAL INSUREDS instructions from the manufacturer, and then repackaged In the otIgInal container: WHO IS AN INSURED Is amended to Include as an Insured any person or organization (called additional Insured) desrrlbod In paragraphs 2.0. through 2,h, a. Any falime to maker such Inspections, adjustments, tests Or servicing as the vendor below whom YOU are required to add as an additloriai Insured on this policy under a written contract or Eras agreed to make or normally undertakes to In agreement but the written contract or agreement must make In the usual course of business, be. oonnootlon with the distribution or sale of the I Currently In offoot or becoming effective during the products; f. Demonstration, installation, servicing or repair , term of this policy,, and. operations, oXOOpt Such Operations performed 2. Executed prior to the "bodily Injury," "property at the vendors premises in Gonneotion with d;jrnags" or "personal and advertising Injury," but the sale of the product, Only the following persons or organizations are ig, Products which, after distribution of sale by you, have been labeled or relabeled or used additional Insureds under this endorsement and coverage provided to such additional Insureds Is as a container, part or Ingredient of any other limited as provided herein: thing or substance by or for the vendor; or , a, Additional Insured —Your Work h. "Bodily lhjur.P or 'property damage" arising out of the sole negligence of the vendor for Its batperson or orgarilzatlon for whom you do work Is an additional insured solely for liability Mage I of 6 (Ed. 06/11) lotb 55 POLICY NUMBER: 84034654035 CAR dome to your negltgenpe specifically resulting from your work for the additional Insured which Is the subject of the written contract or written agreamernt No coverage applies to Ilabllity resulting frorn the sole negligence of the a ' Itlonal Insured, The insurance provldad to the additional insured is limited as follows: (1) The Limits of Insurarnce applicable to the additional Insured are those specified In the written contract or written agreement or in the Declarations of thispolicy, whlohavor Is less, These Limits of Insurance are Inclusive of, and not In addilloni to, the Limlis of insurarice shown in the Declarations. (2) The coverage provided to the additional insured by this endorsement and paragraph F.8, of; the definition of Insured contract` under Liability and Medical Expenses Definitions do not apply to "bodily Injury" or "property damage" arising out of the "products -completed operations hazard" unioss required by the written contractor written agreement, (3) The Insurance provided to the additional insured does not apply to ""bodily injury," "property damage," or "pars&al and advertising Injury"" arising" out of the rendering or failure to render any professional services. b. State or Political Subdivisions A state or political subdivislon subject to the following provisions: (I) This nsmranca following applies Ifor whichrespect ith tothethe state or political subdivision has Issued a permit In connection with premises you own, rent, or control and to which tfmis insurance applies: (a) The existence, malntenance, repair, construction, erection, or removal of adverilsing signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees$ hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or rernoval of elevators; or (2) This Insurance a�plies only with respect to operations pe Vinod by you or on rt behalf for which the state ar poi'itical subdivision has Issued a permlL 613-146932-E (t d. 06111) 88-146932--S (pd, 06111') This Insurance does, not apply to "bodily Injury," "property damage" or "personal and advertlsing Injury" arising out of operations performed for the state or munlcipaI4. c, Controlling Interest Any persons or organizations with a controlling Interest in you but only with respect. to their liability arising out of: (f) Thelrfinencial control of you; or (2) premises they own, maintain or control while you iease or occupy these premises. This Insurance does not apply to slruotural alterations, new construction and demolition. operations performedby or for such additional Insured. d, Managers or Lessors of Premises A manager or lessor of promises but only wfkh respect to liability arlsfng out of the ownership, maintenance or use of that specific part of the premises leased to you and subleot to the following additional exclusions: This Insurance does not apply to: (t) Any."oocurrence" which takes place after YOU cease to be a tenant In that premised, or (2), &ruclural alterations, new construotlon or damolition operations performed by or on behalf of such additional Insured. e. Mortgagee, Assignee or Receiver A mortgages, assignee or receiver but only with 'respect to their liability as mortgagee, asslgnee, or receiver and arlsing, out of the ownership„ maintenance, or use of a promises by you. This Insurance does not apply to structural alteratlons, new constructlon or demolition operations performed by or for such additional Insured. C Own sW0[herInterests —Land Is Leased An owner or other Interest from whom land' has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This Insurance does not apply to: (1) Any "occurrence" which takes place after you cease to loo so that land; or V DQ17 Page 2 of 6 CNA POLICY NUMBER: B40346 54035 (2) Structural alterations, new construotlon or demolition operations performed by or on behalf of such additional Insured. Co-owner of Insured Promises ,A co-owner of a premises oo-owned by you and covered under We Insurance but only with respect to the co-OW110TS liability as Go - owner of such premises,' h. Lessor of Equipment Any person or organization from whom You lease equipment Such person or organization are Insureds only with respect to their liablflty arising, out of the maintenance operation or use by you of equipment leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their written contract or agreement with You for such leased equipment ends. With respect to the Insurance afforded these additional Insureds, the Wowing additional exclusions apply,* This Insurance does not apply: To any "occurrence" which takes place after the equipment lease explr6sl Or (2) To "bodily Injury," "'property damage" or "Personal and advertising Injury" wising out of the We negligence of such additional Insured. Any Insurance provided to an additional Insured designated under paragraphs b. through h. above does not apply to "bodily IdLr/' or "property damage" Included WIthin the "Products -completed operations hazard." 1 The following is added to Paragraph H. Of the BLISINESSOWNERS COMMON POLICY CONDITIONS: H. OthorinsurancO 4. This Insuranoo Is excess over any other Insurance naming the additional Insured as an Insured whether primary, excess, coo.ntIngent or on any other *basis unless a written contract or written agreement speoffloally requires that We Insurance, be either primary or ' primary and noncontributing. 4. LEGAL LIABILITY— DAMAGE TO PREMISES A. Under B, Exclusions, 1. Applicable to Business Llablilty Coverage, Exclusion K SB.146932-E (Ed, O6/1 11) Vll/o SB.146932-E (Ed. 00/11) Damage To Property, is replaced by the following., k. Damage To property 'Property damage'" to: 11, Property you own, rent or occupy, Including any costs or expenses Incurred by you, or any other person, organization or entity, for repair, (oplacement, enhancement, restoration or maintenance of such property for any reason, Including prevention of Injury to a person or damage to another's property; 2. Prernlees you sell, give away Of abandon, If the "property damage"' arises out of any part of those promises; 3. Property loaned to you;. 4. Personal property In the care, custody or control of the Insured; 6. That particular part of any real Property on which y6u of any contractors or subcontractors working dirsotfy or IndIreGlily in your behalf are performing operetlona, If the "property'` 'damage" arises out of those operations; or That, partlatilar part of any properly .that must be restored, repaired or replaced because "your work'" was Incorrectly performed on it. Paragraph 2 of this exclusion does not apply if the promises are "your work" and' were never occupied, rented or hold for rentai by you. Paragraphs 1, 3, and 4, of this excluslon do not apply to 'property damage" (other than darnage by fire or explosion) to promises: (1) ranted to you; (2) temporarily occupied by you vAth the parmigslon of the owner, or (3) to the contents of premises rented to you for a period of 7 Or fewer consecutive days. A separate limit of Insurance applies to Damage To Premises Rented To You as described In Section D — Liability and Medloal Expenses Limits of Insurance, Page: 3 of 6 POLICY NMBER. 84034654035 CNA Paragraphs 3„ 4. S. and ti of this exclusion do not apply to liability assumed under a sidetrack agreement. paragraph 6 of this excluslon does not apply to "property damage" included In the "products-oompleted operations hazard." s. tinder B. Exclusion", 1, A.ppltoable to Business friability Coverage, the fast paragraph of 2. ExolUsIOns Is deletedand replaced by the following; Exciuslons o, d, s, f, g, h.1, k, 1, rn, n, Ind o, do not apply to damage by fire to premises while rented to you or temporarily occupied by you with permisslon of the owner or to the contents of premises rented to you for a perlod o 7 or fewer consecutive, days. A f separate limit of Insurance applles to this coverage as described In Section D. Liability And Medloal Bxponses Limits Of Insurance. . The fret promises RentedhTo Youundert Limit of SOOVOR D. I,lablflty And Medical Expenses Limits Of Insurance Is replaced by the following.,, The most we will pay under Buslness L• Iablllty .for damages because of "property damage" to any Ochs premises, while rented to with he or temporarily occupied by you, permission of the owner, Including contents of sdch premises rented to youfor a period oft or fewer consecutive days, r the r Premises Rented to You limit shown In the Declaration. 5. Blanket Waiver of oubrogatfon We waive any right of recovery we may have against: a. Any person or organization with whom you have a written contract that requires such a waiver. 6, Broad Knowledge of Occurrence The following Items are added to E. Businessowners General Liability conditions In the BusinessowAtiers Liability Coverage Form: e1 paragraphs a, and b. apply to you or to any additional insured only when such °'oocurrenoe," offense, claim or "suit" is known to: (1) You or any additional Insured that Is an Individual; (Ed, 06/11) (2) Any partner; if you or an additional Insured is a partnership; (3) Any manager, If yoQ or an additional Insured Is a Ilmlted liability company; (4) ,Any "executive officer" or Insurance manager, If you or an additional Insured Is a corporation; (5) Any trustee, tf you or an additional Insured Is a trust or (6) Any elected or appointed official, if you an additional insured Is a political subdivision or public entity. This paragraph e. applles separately to you and any additional Insured. 7, Bodily Injury Section F. Liability and Medloal Expsnses Definitions, Item 3, "Bodily Injury° Is delated and replaced with the following, "Bodily Injury" means bodily Injury, slrltness or disease sustained by a person, lnoludIng death, hufmillatlon, shook, mental anguish or mental Injury by that person at any time which results as a consequenoe of the bodily injury, sickness or disease. B, Bxpanded Porional and Advertising Injury Defiraitlon a. The f6bw4119 Is added to Section F. Liability and Medical Expenses DeffnItIons, Itom 14, Personal and Advertising Injury, In the Businassow hers Ganaral Liability Covbmge Forma h. Dlscriminativn or hurnlllation that results In injury to the feelings or reputation of a natural parson, but only If such dlacrlrmlnation or humlllatlon Is: f. Not done Intentionally by or at the direction of a. The Insured, or b. Any „executive officer," director, stockholder, partner, member or manager (if you are a limited liability company) of the Insured; and 2, Not directly or tndlrectfy related to the employment, prospective employment, past employment or terminatlon of employment of any person or person by any insured. b. the following Is added to Exclusions, Section B.: SB -f 46032-E (Ed, 06/11) i � �� ILL i.d ry Page 4 of 6 POLICY NUMBER: 84034654035 CAM (15)DiscrImInatlon RelaUng to ,Froom, Dwelling or Promisee Caused by discrimination dlreclly or Indir6cdy related to the $ala, rental, lease of sub -lease or prospective sale, ramal, lease or sub -lease of any room, dwelling or premises by or at the direction of any Insured. (16)Flnes or penalties Fines or penalties lovled or unposed by a governmental entity beaauae of discrimination, c, This provislon (Expanded personal and Advertising injury) does not apply If a SB -14602 l= (Ed. 06111) 80-146832-Ev (Ed, 46111) paraongl and Advertising Injury Liability Is excluded either by the provislons of tlaa Palloy or by endorsement g. personal and Advertising injury Rendeflned Soctlon F. Liability and Medical pxpsnses I)efinitlons, Item 14, peraonal Advertiaing Injury, Paragraph o. Is replaced by the following: c, The wrongful eviction from, wrongful entry Into, or Invasion of the right of private occupanoy of a room dwelling or promises that a parson or organization oocuples committed by or an behalf of It's Owner, landlord or lessor. Page 6 of 6 In F WITTENT-01 CDILLON GATE (MWODffYYY) CERTIFICATE OF LIABILITY INSURANCE 7/1/2015 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 ISSUINGINSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS -WAIVED, subjecttothe 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 ___rCONTAdT NAME: Western Elite Insurance Solutions PHONE -6900 FAX 140 Diamond Creek Place I No, EA : (916) 259 (AIC, No); (866) 206-8646 Roseville, CA 95747 E-MAIL ADDRESS: INSURED Wittman Enterprises LLC PO Box 269110 Sacramento, CA 95826 (1C)VF:RAr.F.q f FRTACiif dTF N5r IRAnr_D- NSURER(Sl AFFORDING COVERAGE NAIL # INSURER A: Commerce and Industry Ins, Co. INSURER 8 INSURER C INSURER D INSURER E INSURER F: THIS IS TO CERTIFY THAT THE POLICIIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTAMI)INO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THlS 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 ADDLSUBR _—D LTR TYPE OF INSURANCE2LI�YN9M_8ER_... POLICY EFF POLICY EXP M Dfy .,,0!_1!J_DDPfYyYL.( �Lj MO Y Y LILIMITS_­_._---_IN0 COMMERCIAL GENERAL LIABILITY EACHCCCURRrNCE S CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES {Ea occurrence} MEQ FXP (Any one person) PERSONAL & ADV INJURY S GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 POLICY PRO. JECT LOC PRODUCTS - COMP(OP AGG OTHER, AUTOMOBILE LIAWLITY T COMBINED SINGLE LIMIT (Ea accdent) ANY AUTO BODILY INJURY I Per parson) ALL OWNED SDIEDULF-D AUTOS AUTOS BODILY INJURY Peraccdenl) $ NCN-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION $ WORKERS COMPENSATI H- 0ERT -A—CC--ID_E4TAODCERMiEMOWREXCLU AAPLRMOPPLROYS'PLAIARBTINTNEY RJXECUTWE YIN WC065256372 EL EPACRH- 07/01/2015 0710112016 SEATLTE $ 1,000,000 D ? NIA u (MancatMlNH) E.L.I)ISEASE-EAEMPLOYEE $ 1,0()0,000: It gs, describe under D SCRIPTION Or OPERATIONS below E L DISEASE - POLICY OMIT $ 1,000,000 DESCRIPTION OF OPERATf0NSJ LOCATIONS I VEHICLES ¢ACORD 101, Additional Remarks Schedule:, maybe attached if more space Is required) C" C-� L;IzK I It-l(;A I L HULULK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Piz, ACCORDANCE WITH THE POLICY PROVISIONS, Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE �9r t1 1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD WIT'TENT-01 SJEN'KINS ."� r '�►� CERTIFICATE OF LIABILITY INSURANCE DATE(MMrDDfYYYY) 71512016 THIS CERTIFICATE 15 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 policy(les) must 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[CONTACT Western Elite Insurance Solutions 140 Diamond Creek Place Roseville, CA 95747 INSURED Wittman Enterprises LLC PCI Box 269110 Sacramento, CA 96826 259-6900 . INSURERS AFFORDING COVERAGE tNsuRERA;'✓alleywForce Insurance Company INSURERB:Contlnental In urance Compan _.__---- INSURER __ INSURERC Continental Casualty Comm�rany INSURERD':State Compensation Insurance Fund COVERAGES C;:PTIFICATF MI)MRFP— RF'VI1.RIC)M IJIIMRFP- 206-8646 a THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ESSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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, EXCLUSION'S AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _.._... _ 1CY_E __ �. ... ---- AllpLSl7@R".,"_,_, �ti?LICYEFF PCIL.ICYExp I TYPE OF INSURANCE,_.._.._ LTR NSD O POLICY NUMBER (MMIDDIYYYY) MM1DDlYYYY , LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 4,000,000 GIAdMS MADE X j OCCUR CNP6011'187769 07101/2016 0710112017 DAMAGE TO TYENTEO PREMISES (Eaoccurrenea .- ... __...___..�_ $ 300,000 MED EXP (Anyone person) $ 10,000 J ErRsONAL & ADV INJURY p $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: NERAL AGGREGATE $ 2,000,000 F JECOT- [� LOC PRODUCTS COMPIOP AGG $ 2,000,000 INPOLICY OTHER;: I AUTOMOBILE LIABIUTY COMBfNED SINGLE LIMIT LEa accedertik.. 3 $ 1,000,000 i.. B✓+ _ ANYAUTO BUA 6011187724 I 0710112016 0710112017 BODILY INJURY (Per person) $ AUTEDULED AUTOS I __ BODILY INJURY (Per aocldent)SeNON-OWNED I AUTOS AUTOS L PROPERTY DAMAGEHIRED (Per accidar4} , $ i 9 $ I X _.. UMBRELLALBAB X OCCUR EACHOCCURRENCE ._..._..— $ 2,000,000 _— �(', I I EXCESS LIAR CLAIMS -MADE CUP6011187819 07101/2016 07/01/2017 AGGREGATE $ 2,000,000 - - __ DED x RETENTION $ 10,000' $ WORKERS COMPENSATION STATUTE ERH. D AND EMPLOYERS' LIABILITY..... ANY PROPRIETORJPARTNE2fEXECUTIVE Y1N OFFICER/MEMBER EXCLUDED? ElNIA 9161868.2016 07/01/2016 07/0112017 E.L.ACH ACCIDENT – $ 1,000,00_0 (Mandatory Irl NH) E.L. DISEASE - EA EMPLOYEd $ 1,000 000'. It yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY UMIT 1 $ 1,000,000 A Professional Liab CNP6011187769 07/01/2016 0710112017 Each Claim/Agg 1,000,000 DESCRIPTION OF OPERATIONS.I LOCATIONS I VEHICLES (AC©ftp 101, Additional Remarks Schedule., may be attached. If more spade Bs required) v . ....... . ----- City of Santa Ana 20 Civic Center Pia, Santa. Ana, CA 92701 M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE', CANCELLED BEFORE THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEED�REPRESENTATWE �1 f C 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD