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A� or CERTIFICATE OF LIABILITY INSURANCE
<br />DATE l (MMIDDNYYY
<br />e )
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Milestone Risk Management & Insurance Services
<br />License No. OB72766
<br />8 Corporate Park, Suite 130
<br />Irvine CA 92606
<br />CONTACT Cind Hales
<br />NAME: y
<br />aCONNo Ext: (949) 852-0909 FAX No: (949)e52-1131
<br />EMAIL chales@milestonepromise.com
<br />ADDRESS:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURERA:Colony Insurance Company
<br />39993
<br />INSURED
<br />KME/`
<br />2423 Hoover Ave.
<br />Nati.Onal City CA 91950
<br />INSURERB:Ohi.O Security Insurance CompanV
<br />24082
<br />INSURER C: American Fire & Casualty Insurance
<br />24066
<br />INSURER D: Hartford Fire Ins Co
<br />19682
<br />INSURER E :
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:18/19 GL/PL/BA/WC/XSA 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUER
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDONYYY
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 5,000,000
<br />A
<br />CLAIMS -MADE FOOCCUR
<br />DAMAGE O EN ED
<br />PREMISES Ea occurrence
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 25,000
<br />FACE302770
<br />5/19/2018
<br />5/19/2019
<br />PERSONAL &ADVINJURY
<br />$ 5,000,000
<br />G'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 5,000,000
<br />POLICY FIPRO ❑ LOC
<br />Nx-,
<br />JECT
<br />PROOUCTS•COMP/OPAGG
<br />$ 5,000,000
<br />$
<br />OTHER: $2,500 BI/PD Deductible
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />Ea accident)
<br />$ 1,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BM1958331982
<br />11/14/2018
<br />5/19/2019
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED
<br />HIREDAUTOS X AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X
<br />AGGREGATE
<br />$ 1,000,000
<br />C
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />uto xcess is iiy
<br />tONLY
<br />$
<br />ESA1958331982
<br />11/14/2018
<br />5/19/2019
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />D
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? Y❑
<br />(Mandatory in NH)
<br />N /A
<br />72WEZI0371
<br />5/19/2018
<br />5/19/2019
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE . POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Pollution Liability
<br />PACE302770
<br />5/19/2018
<br />5/19/2019
<br />$5.000 DED. Occur/Agg Limit $5,000,000
<br />A
<br />Professional Li.ab/Claims Made
<br />PACE302770
<br />5/19/2018
<br />5/19/2019
<br />$5.000 DED. Occur/Agg Limit $5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />Certificate Holder/Additional Insured: The City of Santa Ana, its officers, employees, agents, and
<br />representatives are hereby named as additonal insured, as required by written contract, per the attached
<br />GL and Auto AI Endorsements.
<br />A "30" day NOC may be given if cancelled.
<br />REVIEWED BY: EUNICE HEREDIA (PG I OF )
<br />CERTIFICATE HOLDER CANCELLATION
<br />The City of Santa Ana (see remarks)
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<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 />AUTHORIZED REPRESENTATIVE
<br />ndy Hales/CHALES
<br />1988-2014
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />CORPORATION. All rights
<br />
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