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ACC>R" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDOIYYYY(
<br />(,..-.��
<br />04/06/2015
<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 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
<br />CONTACT
<br />NAME: Tina Tremaln
<br />Lords Insurance Agency Inc
<br />PHONE FAX
<br />P.O. Box 4419
<br />Me E.t, 714 -487 -5491 Alc Nc: 714 -382 -0574
<br />EMAIL
<br />ADDRESS: tine @lordsinsurance.com
<br />0211212015
<br />Huntington Beach, CA 92605
<br />EACH OCCURRENCE
<br />$ 2006000
<br />License #: OC60258
<br />INSURER(SH AFFORDING COVERAGE
<br />NAIC4
<br />INSURER A: Hartford Insurance Group
<br />INSURED
<br />INSURER B: Republic Indemnity Co. of CA
<br />PREM SES Ea occur ante
<br />MOB Media Inc.
<br />INSURER c: Hiscox Ins Company
<br />MED ERE (Any one person)
<br />DBA Wallgraphic
<br />Business Owners
<br />27121 Towne Centre Dr. Ste 260
<br />INSURER D:
<br />Foothill Ranch, CA 92610
<br />INSURER E:
<br />$ 2,000,000
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 00000000 -0 REVISION NUMBER: 1
<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 />LTR
<br />TYPE OF INSURANCE
<br />ADOLSUBR
<br />POLICVNUMBER
<br />POLICY EFF
<br />MMIDDIYYYV
<br />POLICY EXP
<br />MMIDDIYVYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />57SBAFN6258
<br />0211212015
<br />0211212016
<br />EACH OCCURRENCE
<br />$ 2006000
<br />CLAIMS -MADE F OCCUR
<br />PREM SES Ea occur ante
<br />$ 300,000
<br />X
<br />MED ERE (Any one person)
<br />$ 10,000
<br />Business Owners
<br />PERSONAL& ADV NJURV
<br />$ 2,000,000
<br />GEN'L
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />X
<br />POLICY jEOr El LOG
<br />PRODUCTS - COMPIOP AGG
<br />$ 4,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />57UECAE6580
<br />0511812014
<br />05118/2015
<br />COMBINED EDtSINGLE LIMIT
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS X AUTOS
<br />BODILY INJURY (Per around)
<br />$
<br />PROPERTY DAMAGE
<br />Per accldent
<br />X
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />$
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />S
<br />AGGREGATE
<br />$
<br />EXCESS ILIAD
<br />CLAIMS -MADE
<br />DED I I RETENTION $
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOPJPARTNERIEXECUTIVE VIN
<br />14777616
<br />0110112015
<br />0110112016
<br />X STATUTE IRH
<br />EL EACH ACCIDENT
<br />- - - - --
<br />$ 1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />(Mandatory In NH)
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />describe under
<br />If DESCRI PTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />Professional Liab
<br />USUUA2615049
<br />0312312015
<br />0312312016
<br />occurrent
<br />2,000,000
<br />C
<br />Professional Llab
<br />USUUA2615049
<br />0312312015
<br />03123/2016
<br />aggregate
<br />2,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers,employees, agents, volunteers and
<br />representatives are named as additional insureds ( "additional insureds ") with regard to liability and defense of suits arising
<br />from the operations and uses performed by or on behalf of the named insured. With respect to claims arising out of the
<br />operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary
<br />and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. This
<br />insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the
<br />continued on ACORD 101 Additional Remarks Schedule
<br />CERTIFICATE HOLDER CANCELLATION
<br />I @ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />Printed by TAT on April 06, 2015 at 04:57PM
<br />'/3
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana CA 92701
<br />AIIN
<br />6U` ZEN
<br />TAT
<br />I @ 1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />Printed by TAT on April 06, 2015 at 04:57PM
<br />'/3
<br />
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