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AlC40�RO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (Mm/DDnrrv)
<br />11�sr+"
<br />05/0112015
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS G U fJ'T% ERIJE l� E HOLDER, THIS
<br />CERTIFICATE OR NEGATIVELY AMEND, EXTEND OR ALTER COVERAOE Bi'
<br />DOES NOT AFFIRMATIVELY THE Ah�OR ED 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. CITY nE $ P. e; p I•,
<br />IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must pE 01 s d.fl rSU T,,( I 'WAIVES D, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement, A'St�idm6h[ b-1 tidis erli to t'e does not confer rights to the
<br />certificate holder In lieu of such endorsement (s).
<br />PRODUCER
<br />Lords insurance Agency Inc
<br />CONTACT
<br />NAME: Tina Tremain
<br />PHONE FA%
<br />P.O. BOX 4419
<br />�A pHa.hug.__.714A87_5491 .__,__________ �wc 12¢1: 714.382•_8.57.4_
<br />Huntington Beach, CA 92605
<br />9 ND 8: tina(a�lordslnsurence.com ____ _
<br />?__ -_ 300,000
<br />X
<br />License #: OC60258
<br />— .---- INSURERLS1AFFORDING COVERAGE
<br />NAICa
<br />_ _ __ —_ __ _
<br />INSURERA: Hartford Insurance Group
<br />_
<br />INSURED A/ o8o /p O "1r
<br />MOB Media Inc. / V 7
<br />INSUMEN ., Indemnity Co, of CA
<br />$ 16'060
<br />1RJepublic
<br />NSURE= C_— L31_iC�f]$ YQtRpaD�— __— _._._.....
<br />- --
<br />DBA Wallgraphic
<br />IN&URER.O_.--
<br />27121 Towne Centre Dr. Ste 260
<br />._____
<br />Foothill Ranch, CA 92610
<br />INSURER E:
<br />GEWL AGGREGATE LIMIT APPLIES PER:
<br />X. POLICY PRO-
<br />____ JEOT LOC
<br />GENERAL AGGREGATE
<br />INSURER P:
<br />COVERAGES CERTIFICATE NUMBER: 00000000.673087 REVISION NUMBER: 2
<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 />IN—Si ,"'—'TAD6i3 U -- -'�'� POLICYEPP n— f.—f. --
<br />LTRI TYPE OF INSURANCE ` POLICYNUMBER D IDU.YYY LIMITS
<br />•
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FI OCCUR
<br />Y
<br />57SBAFN6258
<br />0211212015
<br />0211212016
<br />EACHOCCURRENCE
<br />s 2,000,000
<br />A Alb E AE i�TFD
<br />.,P1AWABESIEaeew o
<br />?__ -_ 300,000
<br />X
<br />BU5ine L "wller5
<br />MEDEXP(a,vmle emon)
<br />$ 16'060
<br />_
<br />PERSONAL A ADVINJURY
<br />S 2000,000,
<br />GEWL AGGREGATE LIMIT APPLIES PER:
<br />X. POLICY PRO-
<br />____ JEOT LOC
<br />GENERAL AGGREGATE
<br />$000.000
<br />PRODUCTS AGO
<br />5 .__ 4,000,000
<br />OTHER:
<br />S
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />57UECAE6580
<br />0511812015
<br />0511812016
<br />EPecce EO SINGLE LIMIT
<br />Ea aacmea0 _ _
<br />$ 1,000,000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />X-
<br />ALL OWNED BCHr:OIILEU
<br />AUTOS X AUTOS
<br />NON -OWNED
<br />HIRED AUTOS x- AUTOS
<br />BODILY INJURY (Per accident)
<br />-- - --
<br />S
<br />PROPERTY gMAGE
<br />Pere I 120_._..
<br />S
<br />s
<br />UMDReLLn LIAB
<br />_
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE —
<br />__._ .. ... ..
<br />$
<br />... ............__..___- -____.
<br />EXCESS LIAO
<br />GLAIMSMAUE
<br />DED
<br />RETENTIONS
<br />S
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANYPROPRIETOWPARTNEWEXECUTIVE YIN
<br />OFFICERMEMBER EXCLUI
<br />IMandMOry in Nil)
<br />If yCe, UP.SClAm W der
<br />DESCRIPTION OFOPERATIONS DeI.
<br />NIA
<br />_
<br />14777616 J
<br />01101/2015
<br />0110112016
<br />X I STNTUTE EPH
<br />CI..EACH ACCIDENT
<br />--
<br />S 1000,000
<br />E.L._DISE_A_SE- EA_EM_PLO_YE
<br />"'
<br />E, L. DISEASE POLICY LIMIT
<br />$____1,000,000
<br />$ 1,000,000
<br />C
<br />Professional Liab
<br />USUUA2615049
<br />0312312015
<br />0312312016
<br />occurrent
<br />2,000,000
<br />C
<br />Professional Liab
<br />—
<br />USUUA2615049
<br />--
<br />03123/2015
<br />0312312016
<br />aggregate
<br />2,000,000
<br />—
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS IVEHICLES (ACORD 101, Additional Ra,narksSChadulo. may be aaaohed it more specs le wryulrod)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers,empioyees, 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 />City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<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 />AU
<br />�`'�•✓ r" Y A.!'i / As J (TAT1
<br />I ©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) i7 The ACORD name and logo are registered marks of ACORD
<br />P`- f�.r✓Xt.„ / Printed by TAT on May 01, 2015 at 02:51PM
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