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60 0IJIiJ(- <br />``� b® CERTIFICATE OF LIABILITY INSURANCE <br />5/12/20114 <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 TH FRTWICATR)HOLOEf1;I. f l <br />IMPORTANT: If the certificate holder is an k 110 AL INSURED, t e po 1cy(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 endorseme 6). <br />PRODUCER `- <br />Century Insurance Services <br />16 N. 2nd Street <br />Alhambra, CA 91801 <br />TACT New Century Ins Srv, Inc. <br />NA ENew <br />PHONE (626)300-9000 FAX (626)570-090B <br />'MAILADDRESS.info@usnci. com / License No. OB07085 <br />INSURER B AFFORDING COVERAGE <br />NAIC p <br />INSURER A American Fire and Casualty <br />4066 <br />INSURED I <br />AVT, Inc. (f lJ-t <br />341 Bonnie Circle Ste 102 <br />Corona CA 92880 <br />INSURER B:PBBrless Insurance Company <br />24198 <br />INSURER CNational Union Fire Ins Co Pa <br />19445 <br />INSURERDFOIemoSt Signature Insurance Cc <br />41513 <br />NSURER E <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBERALL 14-15 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 />INSR <br />R <br />TYPE OF INSURANCE <br />DL <br />UBR <br />NUMBER <br />POLICPOLICY <br />MM DDY EFf <br />POLICY <br />O DI UY EXP <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE OCCUR <br />BKA55963427 <br />5 /31/2019 <br />/31/2015 <br />DAMAGE T RENTED <br />PREMISES E rr n <br />$ Soo, 000 <br />MED EXP(Any one person) <br />$ 5,000 <br />PERSONALS AOV INJURY <br />$ 1,000,000 <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GENL AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMPIOP AGG <br />$ 2,000,000 <br />X POLICY PRO LOC <br />S <br />AUTOMOBILE <br />LIABILITY <br />Ea COMBINED SINGLE LIMIT <br />1 000 000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />B <br />ANY AUTO <br />ALL Or SCHEDULED <br />AUTOS AUTOS <br />2442759 <br />/22/2014 <br />/22/2015 <br />BODILY INJURY (Per accident) <br />_ <br />$ <br />PROPERTY DAMAGE <br />raccident) <br />$ <br />HIRE NON'WNED <br />AUTOS AUTOS <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />EACH OCCURRENCE <br />$ 4,000,000 <br />AGGREGATE <br />$ 4,000,000 <br />C. <br />EXCESS LIAB <br />CLAIMS -MADE <br />DE❑ RETENTION <br />$ <br />BU063717909 <br />11/4/2013 <br />1/4/2014 <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN"ITS <br />ANY PROPRIETONPARTNERIEXECUTIVE <br />X I WC STATU- OTH- <br />E.L. EACH ACCIDEM <br />$ 1 000,000 <br />DPFICEWMEMBER EXCLUDED? <br />(Mandatory In NH) <br />NI'1 <br />4007748 <br />/6/2014 <br />/6/2015 <br />E.L. DISEASE -EA EMPLOYE <br />$ 1 000 000 <br />If yes describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASEPOLICYLIMIT <br />$ 1 000 000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddKlonal Remarks Schedule, If more space Is required) <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS <br />ADDITIONAL INSURED PER POLICY FORM NUMBER: CG70020101. THIS CERTIFICATE IS VALID ONLY IF THE CERTIFICATE <br />HOLDER REQUIRES IN A WRITTEN CONTRACT TO BE NAMED AS ADDITIONAL INSURED. THIS POLICY IS PRIMARY S <br />NON-CONTRIBUTORY. 10 DAYS NOTICE OF CANCELLATION FOR NQN PAYMENT OF PREMIUM. 30 DAYS OTHERWISE. <br />As TO F�MM, J <br />CERTIFICATE HOLDER - KOAV v ' I' 1�1 Y�ANCELLATION <br />(714) 571-4211 <br />,;gPPTHE <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />The City O£ Santa Ana <br />WIIStant <br />Parks, Recreation and <br />Community Services <br />it <br />AUTHORIZED REPRESENTATIVE <br />20 CiVic Center Plaza M-23 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />ichelle Shen/BIH <br />ACORD 25 (2010105) <br />INsn2s,]n,onn, n, <br />© 1988-2010 ACORD CORPORATION. All rights reserved. <br />Thu ernan nam. anH lnnn sr. reni.fur.H mark. of ACryRFI <br />