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0F -DATE (d-A-1-.1jDD-N-Y--YYj
<br />ACC)R" CER'rIFICATE OF LIABILITY INSURANCE
<br />1 6/22/2015
<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 Oil 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, (lie policy([es) must be endorsed. If SUBROGATION IS WAIVED, Subject to
<br />the terms and conditions of the Policy, certain Policies may require all endorsement. A Statement on this certificate (foes not confer rights to the
<br />certificate holder Ill HBU Of SUCh endorsernent(s).
<br />CONTACT
<br />f'RODUCERGarretUMosier/Griffith/Sistrunk N&k�E` "
<br />Risk Management & Insurance Services PHONE.——� Fax
<br />I Ale, NO): (949 559-6703
<br />JAK,No Exll,
<br />12 TrUrnan E-MAIL
<br />III CA 92620 INS E�ijs)'AFFORUING COVERAGE
<br />NAIC h
<br />VAWI,grllgS.Corn OB84519 INSURER A: The Ohio Casualty insurance Company k4066
<br />24074
<br />1
<br />INSURED rPerkinspSt.ty Services, Inc, INSURER 13 � American Fand CagUaltv
<br />108
<br />eior Proer
<br />Su SURER 1�: Cypress Ins�reurance CompanyCompany 2... 10855
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<br />99
<br />Pico Rivera CA 90660
<br />!!l §'URER
<br />III SURER F:
<br />Prlvlqlntd wil"pPr?.
<br />THIS $S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN POLICY EFF POLICYEXP LIMITS
<br />L SRI ININVOONYYY) (Im'110
<br />TR TYPE OF INSURANCE POLICY NUMBER
<br />AI/
<br />20 Civic Center Plaza (M-30)
<br />COMMERCIAL GENERAL LIABILITY
<br />P,O. BOX 1988
<br />BKO(18)56589876
<br />6122/2015
<br />6/2212016
<br />EACH OCCURRENCE
<br />5 1,000,000
<br />"IMS-MADIF OCCUR
<br />An one person)
<br />S 15,000
<br />—OOP
<br />__LjEy,tXP
<br />8 AOV INJURY
<br />$ 1,000,000
<br />_RIERSONAL
<br />GENERAL AGGREGATE
<br />S 2,000,666
<br />PRODUCTS - COMPIOP AGG
<br />S 2,000,000
<br />PRO-
<br />POLICY D JECT LOC
<br />OTHER
<br />B
<br />AUTOMOBILE LIABILITY
<br />BAA(16)56580876
<br />6/22/2015
<br />6/22/2016
<br />COMBINED SING LF LIPMT
<br />JI accidenij
<br />S 1,000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />.. .. . . .......... ................ .... .. . . .
<br />S
<br />ALL OWNILL) SCHEDULED
<br />BODILY INJURY (Per ac6dent)
<br />S
<br />AUTOS AUTOS
<br />NON-O'ANED
<br />PROPERTY
<br />HIRFDAUTOS AUTOS
<br />$500 Coll Ded
<br />- (Pquq9.cq0!L . . ........
<br />$500 Comp Ded
<br />UMBRELLA LIAR T-
<br />OCCUR
<br />--T
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />EXCESS LIAR,
<br />DERETENTION S
<br />S
<br />C
<br />WORKERS COMPENSATION
<br />SUVVC604101t
<br />6)2212016
<br />PERT OTT -
<br />I/ I TA IT; IER
<br />AND EMPLOYERS
<br />S'
<br />ANY PROPR I[ItO' VPAR TNE R, EXEC U TjVr YIN
<br />EXCLUDED? "
<br />N IA
<br />pejke *ed
<br />I
<br />E L EACH ACCIDENT
<br />S 1,000,000
<br />EL DISEASE - EA EMPLOYEE
<br />S 1,000,000
<br />OFFICER,MEMBER
<br />(Mandatory In NH)
<br />EL DISEASE -POLICYLIMIT
<br />S 1,000,000
<br />H gs, descrIbe under
<br />0 S I N OF OPERATIONS be!ow
<br />;oo
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tO I Additional "Redlariiillgc.h' 0 'Ita-diod If morr, space Is required)
<br />As respects General Liability coverage, City of Santa Ana, its officers, employees, agents, volunteefs and representatives are added as Additional
<br />IIlSUred9 and thus insurance is primary, per CGB8100413 attached.
<br />I— ['Ahlfl1-1 I A I It IN
<br />V 1VOIS-ZLI 14 A�1UNU
<br />ACORD 25 (2014/011) The ACORD name and logo are registered marks of ACORD
<br />25203100 1 15-16 A M/G/,;Al [ J—Iymn Ro— I r12a12VIS 1:33�;5 fv Ux9 I W
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Clerk of the City Council
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza (M-30)
<br />P,O. BOX 1988
<br />Santa Ana CA 92701-1988
<br />AUTHORIZED REPRESENTATIVE
<br />MIChael Finn
<br />V 1VOIS-ZLI 14 A�1UNU
<br />ACORD 25 (2014/011) The ACORD name and logo are registered marks of ACORD
<br />25203100 1 15-16 A M/G/,;Al [ J—Iymn Ro— I r12a12VIS 1:33�;5 fv Ux9 I W
<br />
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