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i <br />.�►CCAR P CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDD/YYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />1 03/0412016 <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 CONSTIT'U'TE 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 <br />CONTACT' <br />NAME: <br />Hiscox Inc. d /bfaf Hiscox Insurance Agency in CA <br />PIJC. N , (888) 202 -3007 <br />520 Madison Avenue <br />ADDRESS, contact @hiscox.com <br />32nd Floor <br />UNSURER(S) AFFORDING, COVERAGE NAICfl <br />New York, NY 10022 <br />INSURER A: Hiscox Insurance Company Inc 10200 <br />INSURED <br />INSURER B <br />DAMAGE TO RENTED <br />PREMISE$ {Ea accurrence <br />STRAIGHTLINE COMMUNICATIONS <br />INSURER ,C <br />14930 Greenleaf Street <br />INSURER D <br />INSURER E: <br />Sherman Oaks CA 91403 <br />INSURER F: <br />A <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 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 ADDL SUER POLICY NUMBER POLICY D(YYYM POLICY YYY LIMITS <br />LTR <br />COMMERCIAL GENERAL UABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE X OCCUR <br />- <br />DAMAGE TO RENTED <br />PREMISE$ {Ea accurrence <br />S 100,000 <br />MED EXP (Any one person) <br />S 5,000 <br />A <br />Y <br />UDC- 1531232- CGL -16 <br />01/1212016 <br />01/1212017 <br />PERSONAL sADVINJURY <br />5 0 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE, <br />s 2 „000,000 <br />PCLICY Iii JE� .� LOC <br />PRODUCTS - COMPIOPAGG <br />s SIT Gen. Agg _- <br />OTHER: <br />OTHER: <br />S <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />S <br />ANY AUTO <br />BODILY INJURY (Per person) <br />5 <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />S <br />PROPERTYDAMAGE <br />Par accident. <br />S <br />NON -OWNED <br />HIREDAUTOS I AUTOS <br />Is <br />UMBRELLA LIAR <br />HCLAIM3-MADE <br />OCCUR <br />EACH OCCURRENCE <br />'.... s <br />EXCESS LIAR <br />AGGREGATE <br />OED RETENTIONS <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIAB➢L1TY Y / N <br />AN!VPR IETORIPARTNERIEXECUTIVE <br />OFFVCERIME.MBEREXCLUDED7 <br />(Mandatory in NH) <br />NIA.. <br />PER OTH- <br />STATUTE ER <br />F.L. EACH ACCIDENT <br />S <br />._E.L. DISEASE -EA EMP'LOYFEII <br />S <br />If Yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />_ .....................,. m...,...,... ....._....,........_......._... <br />E.L. DISEASE - POLICY LIMIT <br />..... <br />S <br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />The Clty of Santa Ana and its officers, employees, agents, volunteers and representatives each white acting under the direction of The City of Santa Ana are <br />named as additional insureds. <br />Lwl i�I�lIh511��a�JAIIJ�'. •le'IeI"glAlWG71lIIJe <br />The 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 />@ 1989 -2014 ACORD CORPORAT'I'ON. Ali rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />