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<br />11AG A
<br />1A1C11{MG ,GJ�Yp '
<br />ACORD. CERTIFICATE OF LIABILITY INSURANCE OAT 151'20aNWY)
<br />2/15/018
<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 en ADDITIONAL MSURED, the policy(les) must hove ADDTIONAL INSURED provisions or b endorsed.
<br />It SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement A statement on
<br />this certificate does not confer any rights to the certificate holder in lieu of such endarsemeni(s).
<br />PRODUCER
<br />BB&T Insurance Services
<br />WEt. Aide Radilla
<br />'N 41-2850 F NPI: 877 297-9245
<br />of Orange County
<br />AaeAESS: aradilia@bbandt.com
<br />2400 E Kalella Ave. Suite 1100
<br />Anaheim, CA 92006
<br />INSWERISI AFFOMOM COVERAGE NAIC0
<br />INSURER A:1UImLLICSF"51nNmol,nLOmpmr
<br />27154
<br />UNSURE°
<br />Compulink Mgmt Center Inc
<br />INSURER B: 71m 1Y Ra t'Q, mA'Coel Avm
<br />25674
<br />INSMER c: ACE AmnIce,Navu,upe
<br />22667
<br />dba LaserOche
<br />3545 N. Long Beach Blvd. 9110
<br />Long Beach, CA 90807
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />n e're AI„eeG tee. REVISION NUMBER:
<br />cc'.MRnvw ......... ...... _.._...__...
<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'INSURMICE 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 />R
<br />LTR
<br />TYPECI'MURANCE
<br />Ati0
<br />NSR
<br />R
<br />VAm
<br />POLICY NUMBER
<br />I•°LILY EFF
<br />NMNOIYYV)Q
<br />LTCYExB
<br />M{ MNONY
<br />LINK$
<br />A
<br />X
<br />OOMLIERCIALGENERALUABILaY
<br />CLAIMS MAOE ❑X OCCUR
<br />X
<br />7110103310011
<br />2/1312018
<br />0211312019
<br />EncHo:cuRRENCE
<br />S1,000,000
<br />OA�TILAI ronENTEO
<br />P ��slEaeavrrenx
<br />51000,000
<br />MED EXP (n onepele )
<br />$10 000
<br />PERSONAL A AOV KJURY
<br />$1,000,000
<br />GENL AGGREGATE LUIIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />32,000,000
<br />.. PRO.T$-COMPNPAGD
<br />s2,000 000
<br />—_
<br />A
<br />Pn0
<br />POLICY � dECT � LOC
<br />OTHER:
<br />AUTOUOOILELIAOILRY
<br />7110103310011
<br />2/1312018
<br />02/1312019
<br />(Ee„�,dINEdiIc[€iTMr
<br />3
<br />$1,000,000
<br />BODILY INJUIIY lPtt poem)
<br />9
<br />X ANY AUTO
<br />BODILYINJuRY(PeraaMeN)
<br />S
<br />OLVNEO SCHEDULE°
<br />AUT ONLY AUTOS
<br />X AUT(W ONLV x AUTTOG EOMY
<br />Op2RTy0AFARSE-
<br />Ptt AaideN
<br />S __
<br />S
<br />A
<br />X
<br />UMBRELLA LIAR
<br />EXCESS LIAO
<br />X
<br />OC(U1R
<br />CWAISAIADE
<br />7110103310011
<br />211312018
<br />02/1312019
<br />FAdI OrsuRnencE
<br />s20 000.000
<br />AGGREGATE
<br />s20000,000
<br />DEO RETENTION$
<br />WORKERSCOLVENSpTION
<br />Ana EIdPLOYERB' LNBLLBT
<br />ANY PROPRIETORIPARTNERRECUTNE YIN
<br />OFFlM"WBER EXMEJ
<br />(Ll atagrInNH)
<br />R YyaC8.� d=1W UINN
<br />GESC:RIPTIONOFOPERATXINSbeb
<br />X 5TATvTE OTH-
<br />S
<br />B
<br />NIA
<br />U84K964027
<br />1l01I201801101/201
<br />EL EAd1ACdDENT
<br />$_JUDO OOO
<br />EL DISEASE -EA EMPLOYEE
<br />S1tn,000
<br />EL. DI SEASE.POLX:YUNT
<br />$1000,000
<br />_
<br />C
<br />Technology
<br />G46867680001
<br />2113/2018
<br />0211312019
<br />$16,000,000 Agg Limit
<br />E & O -
<br />$16,000,000 Each Claim
<br />Relro 2/13/2004
<br />L
<br />$ 50,000 Retention
<br />DESCRIPTION OF OPERATIONS ILOGATIOUS IVEHICLES (ACORD 101, AddRimal ROMO As SchNdtde, III' be anached X more spat* IS IOVlred)
<br />RE: Contract agreement with Insured.
<br />Certificate holder is Included as Additional Insured, as respects to General Liability, as required by
<br />written contract, per form #VCG207 0709 attached.,,, " r
<br />ICE �IA ,3�5 1(,L
<br />City of Santa Ana
<br />20 Civic Center Plaza M-42
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE TIEREOF. NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REP IESEmATNE
<br />ACORD 25 (2016103) 1 all
<br />694 NS19537247/M19537241
<br />IUpO•cV a nLvnv ,...nr... o........ .... ..y....
<br />The ACORD name and log"
<br />17 irks of ACORD
<br />L I �7 AFRAD
<br />
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