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21100-0000 HBCT04
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<br />i DATE
<br />CERTIFICATE OF LIABILITY INSURANCE �
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<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 holier is Sn ADDITIONAL INSURED, the Policy(les) must have ADDITIONAL INSURED provisions orb* 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 co_nf_e_r ri hts h> the certificate holder In fieu of such endorsomont(s),
<br />PRODUCER License il• 0554249 CO jaCT -' ---�
<br />Heffernan Insurance Brokers PHore- `"' _.._` �----
<br />18004 SR Park Circle, Sulte 210 I= en.y _1 (949) 771 9400 We qq 949) 771.9401
<br />IN111% CA 92614
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<br />11N8URLRA Nonpro ItE Insurance Alliance a(Cahfor_nia
<br />INSURED IN¢URBRB QBE Insurance C J
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<br />2-1.1 Orange County---- - _0(ailOn _
<br />I.- SURER C.
<br />1605 E. 17th Street
<br />Sidle fog I INSURERS,�
<br />Santa Ana, CA 92705 INSuneE
<br />INSURER Fes-
<br />GERTIFICATk NUM6ER: __� _ —�^_ RFVISI, N N,_U�96GR:— __ l_~
<br />CTHIS
<br />THIS
<br />ISTO CERTIFY
<br />IS TO CERTIFY THAT 7h1E POLICIES OF
<br />INSURANCE
<br />LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED.
<br />NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT NTH RESPECT TO WHICH THIS
<br />CERTIFICATE
<br />MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFPOROEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 7ERM5,
<br />EXCLUSIONS
<br />AND CONDITIONS OF SUCH POLICIES,
<br />- —'
<br />LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />SUBRr
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<br />POLICY NUMBER POIJOY EFF POIICYE%PT GMITa
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<br />F,ACH CICCURRENCE S 11000,000
<br />DAMAGETORENTED
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<br />TYPE OF INSURANCE �_ __
<br />COMMERCIAL GENERAL LIABI TY
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<br />SOC(AL SERVICE I$ 1,000,06E
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<br />DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (ACORD iPi, AedalcnN Remarks 5cltadula, may ba anauhed if mam eVava la requlretl) �-
<br />Re: As Par Contract or Agreement on File with Insured. City of Santa Ana, Community Development Agency Is Included as an additional Insured Primary)
<br />(and
<br />on General Liability policy per the attac hod endorsement, If required.
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of Santa And
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency.
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Administrative Services Division M-29
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaia
<br />Santa Ana, CA 92701
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<br />ACORD 25 (2015/03) R11988,2015 ACORD CORPORATION. All rights reserved.
<br />'rho ACORD name and logo are registered marks of ACORD
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