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DATE (MMIDDfYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE,6/202017
<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 lieu of such endorsement(s).
<br />PRODUCER CONTACT
<br />NAME: Della January
<br />Barbary Insurance Brokerage PHONEFA%
<br />230 California Street, Suite 700 (AC,No, Ext): 415-788 4700 (AIC, Na), 415-788-4701
<br />San Francisco CA 94111 ADDRESS: Della@barbaryinsurance.com
<br />INSURER A: Nonprofits Ins Alliance of CA 52412.6
<br />INSURED WEARE-1 INSWRERB;North American Elite
<br />Shift Design, Inc. INSURER C:
<br />2655 Harrison Street _
<br />San Francisco CA 94110 � INSURER Vis.
<br />p ` G'" a d � tlNSURERE:
<br />rr)VI=Pnrl=G rFPT'IFIrATr tilIMFRFR. 201000064 RFVIGIr7N NnIMRPIP.
<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 TYPE OF INSURANCE IN
<br />DL SUER - POLICY EFF POLICY E%P LIMITS
<br />''..... LTR INS® YYVD POLICY NUMBER MMIDDlYYYY MMlD61'YYYY
<br />A X COMMERCIAL GENERAL LIABILITY Y 2016-42064-NPd 12!3!2016 12/312017 EACH OCCURRENCE 51,000,000
<br />DAMAGE TO RENTED
<br />CLAIMS -MADE 1 X.._. OCCUR . PREMISES (Ea occurrence) 5600,000
<br />MED EXP (Any one person) $20,000
<br />i
<br />PERSONAL. & ADV INJURY $1'.,000,000..
<br />GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $2,000,000
<br />X _ POLICYPRC LCC PRODUCTS - COMPIOP AGG $2,000,000
<br />_.. JEGT
<br />OTHER: Liquor Liability $1,000,000
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
<br />(Ea accident)
<br />.. ALL O'u`JPJ b.✓ BODILY INJURY (Per person) $
<br />ANY AUT
<br />ED SCHEDULED !
<br />AUTOS AUTOS BODILY INJURY (Per accident) $ _. ..
<br />'"`w,
<br />NON -OND b w PROPERTY DAMAGE
<br />HIRED AUTOSAUTOS '. o (Per accident),,, $
<br />UMBRELLA LIAR.
<br />CCCUR +k,O. �, EACH OCCURRENCE
<br />CLAIMS- $
<br />EXCESS LIAR AGGREGATE.
<br />'..... DED ' RETENTIC7N$ MADE�'",
<br />.,
<br />WORKERS COMPENSATION '" ,` i PER OTH
<br />AND EMPLOYERS' LIABILITY STATUTE ER
<br />:ANY PROPRIETORIPARTNERYEXECUTVE F�.. N ! A ,^� ' E1 EACH ACCIDENT $
<br />OFFICERIMEMBER EXCLUDED? _ .
<br />(Mandatary in NH) E.L DISEASE EA EMPLOYEE $
<br />I'm describe Under .._ .._. .... __.
<br />DCRIPTION OF OPERATIONS below '... E.L DISEASE -POLICY LIMIT $
<br />B Commercial Property 2016 -42084 -PROP 1213/2015 1213/2017 BPP Limit $10,000
<br />DESCRIPTION OF OPERATIONS f LOCATIONS f'VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
<br />The City of Santa Ana, its officers, employees, agents, and representative are named as additional insured per endorsement CG20370704.
<br />With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance is afforded by
<br />this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insured.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<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 />'.�.^dltir t�
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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