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Client #:1722613
<br />141 PTIUSACO
<br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />4/21/2016
<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 IIGU of such endorsement(s).
<br />PRODUCER
<br />BB &T- Atlantic Risk Management
<br />5850 Waterloo Road, Suite 240
<br />CONTACT Jennifer Burton
<br />NAME:
<br />(PA HONE qq0 480 -4400 866. 549.3345
<br />e Est: A /C, No:
<br />E-MAIL
<br />ADDRESS: jennifer.burton @bbandt.com
<br />Columbia, MD 21045
<br />410 480.4400
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURER A: Hanover Insurance Company
<br />22292
<br />INSURED A �Cy" (,�"g � �iJ
<br />PTI US Acquisitions LLC
<br />1001 Yamato Road, Suite 105
<br />Boca Raton, FL 33431
<br />INSURER B:
<br />$1,000,000
<br />INSURER C:
<br />X COMMERCIAL GENERAL LIABILITY
<br />INSURER D:
<br />INSURER E:
<br />INSURER F:
<br />PREMISESOEeawTUrrence
<br />$1,000,000
<br />COVERAGES CERTIFICATE NUMBER: 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 />LTR
<br />TYPE OF INSURANCE
<br />NSR
<br />WVD
<br />POLICY NUMBER
<br />MMIDDIYEFF
<br />MMI�DmYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />RHQA52340101
<br />1/01/2016
<br />01/01/2017
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />PREMISESOEeawTUrrence
<br />$1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />MED EXP(Any one person)
<br />$10,000
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS- COMP /OP AGO
<br />$2,000,000
<br />POLICY PRO X LOC
<br />EDT
<br />$
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />RHQA52340101
<br />1/01/2016
<br />01101/2017
<br />EeeBINEDSINGLE LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY(Peraccident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />•
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />UHQA52340201
<br />1/01/2016
<br />01101/2017
<br />EACH OCCURRENCE
<br />$5000000
<br />AGGREGATE
<br />$5,000,000
<br />EXCESS LIAB
<br />CLAIMS MADE
<br />DED I I RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />ANYPROPRIEEOR /PARTNER /EXECUTIVE YIN
<br />OFFICER /MEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />p
<br />pVe G`^ ( �
<br />FAO �I
<br />`y'
<br />"-
<br />WC STATU- OTH-
<br />E EACH ACCIDENT
<br />$
<br />E. L. DISEASE LA EMPLOYEE
<br />$
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E. L. DISEASE - POLICY LIMIT
<br />5
<br />cjl�VtcA ,X
<br />V a5
<br />dgCp�1�.
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlo,ip chedule, if more space is required)
<br />RE: US -CA -1013
<br />If required by written contract, The City of Santa Ana, it's officers, employees, agents, and
<br />representative are named as additional insured on the General Liability policy, subject to policy
<br />provisions. A 30 day notice of cancellation applies in favor of the certificate holder with regards to the
<br />General Liability policy.
<br />(See Attached Descriptions)
<br />City of Santa Ana
<br />Parks, Recreation & Community Services
<br />Agency - M23
<br />20 Civic Center Plaza, 2nd FL., RM #272
<br />Santa Ana, CA 92702
<br />ACORD 25 (2010105) 1 of 2
<br />#S160298471M15641794
<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 />@ 1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />RMMIL
<br />
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