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ACORV CERTIFICATE OF LIABILITY INSURANCE
<br />OATE(MM/DD/YYYY)
<br />1!7/2019
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements .
<br />PRODUCER
<br />CONTACT
<br />NAME: MoMo McDonald
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. LIC. # 0726293
<br />F
<br />818.539.8825 :818.539.8725
<br />ao AIL maureen modonald a' .com
<br />505 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />INSURERS) AFFORDING COVERAGE
<br />NAIC#
<br />_ _
<br />INSURERAI Berkle National Insurance Company
<br />38911
<br />INSURED INTEHOU-03
<br />INSURERS: New York Marine And General Insurance Compaq 16608
<br />Interval House
<br />P.O. Box 3356
<br />INSURER C: Lloyd's Syndicate 2987 _
<br />Seal Beach, CA 90740
<br />INSURER D__
<br />INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: 671146757 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INTR(
<br />TYPEOFINSURANCE
<br />I D Ua
<br />_ POLICY NUMBER
<br />MMNDYYFY
<br />MMO D/YYXYY
<br />LIMITS
<br />A
<br />X COMMERCIALGENERAL LIABILITY
<br />Y I
<br />HHS8525626.12
<br />10/l/2018
<br />10/1/2019
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OOCCUR
<br />I
<br />PR AISES(Ee Sap m i
<br />$500,000
<br />EXP tAr one�rson)
<br />$10,000
<br />j�M_EO
<br />PERSONAL 8 ADV INJURY
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE
<br />$3,000,000
<br />%t POLICY IF7 JECT LOC
<br />i
<br />PRODUCTS-COMP/OP AGG
<br />$3,000,000
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />COMRINEO SINGLE LIMIT
<br />E ent
<br />$
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />�BODILY INJURY (Per accidenn
<br />I PROPERTVDAMAGE
<br />' (Per accidenll
<br />$
<br />$
<br />r
<br />$
<br />I
<br />I
<br />I
<br />C
<br />UMBRELLALIAB
<br />X
<br />X
<br />OCCUR
<br />NPXS20180025
<br />10/1/2018
<br />1011/2019 EACH OCCURRENCE _
<br />$2,000,000
<br />$2.000,000
<br />EXCESS LIAS X
<br />CLAIMS -MADE
<br />AGGREGATE
<br />DED I X RETENTION
<br />$ Included
<br />Sexual misconduct
<br />B WORKERSCOMPENSATION V
<br />AND EMPLOYERS'LIABILRY
<br />'ANVPROPRIETOR/PARTNERIEXECLITIVE Y'.
<br />'OFFICER/MEMBEREXCLUDE07 INIA
<br />WC201800005078
<br />2/1/2018
<br />2/1/2019 X PER I IOTH-
<br />, STATUTE E
<br />E L_. EACH ACCIDENT
<br />-—
<br />$1,000,000
<br />— — -
<br />$1,000,000
<br />(MandatoryinNH)
<br />E. L. DISEASE - EA EMPLOYEE
<br />If yes describe under
<br />DESCRIPTIONOFOPERATIONSbeloar
<br />- -- --- ""'—"—
<br />EL. DISEASE -POLICY LIMIT
<br />— —'—
<br />$1,000,000
<br />A Property Coverage
<br />i HHS8525626-12
<br />10/1/2018
<br />10/1/2019 Blanket Building
<br />$4,934,910
<br />BPP Limit
<br />$815.000
<br />Deductible
<br />$1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONSI VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached it mom spars Is required)
<br />Policy: Crime Coverage
<br />Policy Term: 12/01/2018 To 10/01/2019
<br />Policy Number: UC11717955,18-038
<br />Carrier: Underwriters at Lloyd's, London
<br />Employee theft: $3,000,000 /Deductible: $25,000
<br />ERISA: $3,000,000
<br />Theft of money and securities: $3,000,000 / Deductible : $25,000
<br />Money and Securities: $3,000,ODO / Deductible : $25,000
<br />See Attached...
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Community Development Agency (M-25)
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Administrative Services Division
<br />Attn: Terri Eggers
<br />20 Civic Center Plaza, M-25
<br />AUTHORIZED REP ESENTATIVE
<br />k t p
<br />Santa Ana, CA 92701
<br />t"121LLt .,
<br />0
<br />®1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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