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<br />A ®® CERTIFICATE OF LIABILITY INSURANCE
<br />011/29ATE I/2017V)
<br />il/29/201T
<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 pollcy(les) 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 endorsement(s).
<br />PRODUCER
<br />ONTACT
<br />Willis of Seattle, Inc.
<br />c/o 26 Century Blvd
<br />P.O. Box 305191
<br />PRONE 1-877-845-7375 FAX 1-888-467-2378
<br />C o:
<br />M�FIU•
<br />ADDRESS: Corti€i0atea@wi1119.com
<br />INSURER(3)AFFORDING COVERAGE
<br />NAICB
<br />Nashville, TN 372305191 USA
<br />INSURERA; Cove-ys Specialty Inaurance Company
<br />15686
<br />INSURED
<br />INSURERBt Greenwich Insurance Company
<br />22322
<br />Cara Ambula.ca services, Ino.
<br />1517 West Braden Court
<br />—
<br />INSURERC: steadfast Inaurance Company
<br />26387
<br />INSURERD: XL Specialty Insurance Company
<br />37885
<br />Orange, CA 92868
<br />INSURER E;
<br />X
<br />MED EXP (Any one arson) $ 5,000
<br />INSURER F: mm
<br />Products -Claims Made
<br />COVERAGES CERTIFICATE NUMBER: W4491393 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 />:LTR
<br />TYPE OF INSURANCEADOL
<br />SUBR
<br />POLICY NUMBER
<br />POLI YEFF
<br />DD riI
<br />POLICY EXP
<br />(MMIOOYYYYI
<br />LIMITS
<br />X
<br />COMMERCIALOENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,000
<br />CLAIMS -MADE I OCCURREMIS
<br />T R 1,000,000
<br />ftE SES Ea occurrence $
<br />X
<br />MED EXP (Any one arson) $ 5,000
<br />A
<br />Products -Claims Made
<br />y
<br />5-10013
<br />10/01/2017
<br />10/01/2018
<br />PERSONAL &ADV INJURY $ 1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEHL
<br />X
<br />POLICY ❑ JEC ❑ LOC
<br />PRODUCTS -COMPIOP ADD S 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILELIASILITY
<br />COMBINED SINGLE LIMIT $ 1,000,000
<br />ac dent
<br />_
<br />BODILY INJURY(Perpersan) $
<br />X
<br />ANY AUTO
<br />B
<br />OWNED
<br />AUTOS DONLY quTESULED
<br />y
<br />RAD500047602
<br />10/01/2017
<br />10/01/2016
<br />BODILY INJURY( Per ecciden0 $
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />PROPERTY DAMAGE --
<br />Per mid 1 t $
<br />C
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 15,000,0DO
<br />AGGREGATE $ 15,000,000
<br />X
<br />EXCESS UAD
<br />CLAIMS -MADE
<br />y
<br />UPID5414770-04
<br />10/01/2017
<br />10/01/2018
<br />DED ETENTION
<br />S
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETORUPARTNERIEXECUTIVE YIN
<br />OFFICER/MEMOEREXCLUDED7 N°
<br />(Mandetoryin NH)
<br />NIA
<br />RM3000955-02
<br />10/01/2017
<br />10/01/2018
<br />X I PTRTUT ERN
<br />--
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE -EA EMPLOYEE $ 1,000,000
<br />Ifyas,descdbe Littler
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />A
<br />Mie. Medical Professional
<br />5-10013
<br />10/01/2017
<br />10/01/2018
<br />Per Claim $1,000,000
<br />Liability
<br />Aggregate $2,000,000
<br />Claims Made
<br />Abuse S Molestation $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 7,7-17
<br />7
<br />I(.Y / /_../'%
<br />This Voids and Replaces Previously Issued Certificate Dated 10/24/2017 WITH ID: W4092490.
<br />Umbrella/Excess Follows Form. (-n '
<br />The City of Santa Ana and their respective officers, officials, employees, representative and volunteers are included
<br />as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />sa -0, 15362924 vacs: 526623
<br />
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