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/-� ® DATE {MMIODIYYYY)
<br />?® CERTIFICATE OF LIABILITY INSURANCE 1/za/zols
<br />THIS CERTIFICATE IS ISSUED ASA 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 PRODUC ANIz., H CER ICATI- OLDER.
<br />IMPORTANT: If the certificate hol r is=en DIT _ - A "INSI7RED, the pclicy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
<br />the terms and conditions of the pollcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate. holder in lleu of suc. e ps 1rLents, -,,1-r ;'CCU_ + c
<br />PRODUCER 3 I ;...y r 1I. l`
<br />Daly
<br />Daly Merritt Insurance
<br />100 Maple
<br />NAMEAC Cathy Stannls-REP
<br />PHONE PHONE .ESI (734)283--
<br />.EMAIi so4gs�hy..V..._.St. a_n_ni.s@dalymerritt.com _
<br />INSURER(5) AFFORDING COVERAGE _,
<br />NAIC k
<br />Wyandotte MI 48192
<br />INSURERAPhoenax Insurance Co.. 125623
<br />INSURED
<br />.INSURER B:TISY_ale_r$ ProDerty,,,_Casualt TCo. of
<br />,25674
<br />FAAC Inc. N-ZOIC)-Q'%(pFNsuRERc.The
<br />Standard Fire_ Ins.. Co,
<br />119070
<br />1229 Oak Valley Drive
<br />INSURERD:Gemini Insurance Co..
<br />MED EXP An one-Qerson
<br />Ann. Arbor MI 48108-9675
<br />INSURER F:__
<br />Cr1VFRA(LF9 CERTIFICATE NUMBER:CL1612810651 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 CONTRACTOR 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__MA_Y_H_AVE BEEN REDUCED BY PAID CLAIMS,
<br />_ _
<br />ILTR -� TYPE OF INSURANCE. v�- AOOL SO> W VVn POLICY NUMBER 1-POL1C(MWDDrcE' PMLICOYE P LIMITSw-
<br />COMMERCIAL GENERAL LIABILITY
<br />I
<br />-
<br />l
<br />EACH OCCURRENCE-
<br />:1,.000,000
<br />A CLAIMS ❑ OCCUR
<br />!
<br />FaEt�1SIESjEs ��,urrenc(
<br />_
<br />$ 1,000,000
<br />-MADE
<br />MED EXP An one-Qerson
<br />$ 10,000
<br />_e tivmmN^�
<br />r ,630-7F27694A
<br />I
<br />5/1/2015
<br />5/1/2016
<br />PERSONAL&ADV INJURY,_
<br />GENERAL AGGREGATE
<br />It 1,000{000
<br />-
<br />$ 2,000,000
<br />I
<br />GENLAGGREGATE LIMITAPPLIES PER
<br />PRODUCTS - COMP/OPA$
<br />2r ODOr000]POLICY ...
<br />�PRO-
<br />1-1 ECT❑LOC
<br />f I:OTHM.
<br />1
<br />j
<br />I
<br />Employee Benefits 1$
<br />1;000,000.
<br />I AUTOMOBILE LIABILITY
<br />OMBINEtl SINGLE LIMIT$
<br />cla tt1
<br />1,000,000
<br />B ANY AUTO
<br />'
<br />I
<br />BODILY INJURY
<br />ALLOWNED SCHEDULED
<br />iBA-7F27694A-15
<br />5/1/2015
<br />5/1/2016
<br />BODILY INJURY (Per accident)�S
<br />I AUTOS AUTOS
<br />i NON -OWNED
<br />HIRED AUTOS AUTOS
<br />i$
<br />=
<br />I
<br />j
<br />—POE TY CA AGE
<br />Per eccldentj_,_,_„�
<br />it
<br />7 ---.-- -
<br />Pro ertdame a Buyback
<br />$$
<br />€�;'_X�'''if[UMBRELLA UAB X
<br />B ' k EXCESS LAB (
<br />OGCUR
<br />CLAIMS MADE
<br />,
<br />j
<br />I .).HSM-CUP-7F27694A
<br />E
<br />5/1/2015
<br />!
<br />5/1/2016
<br />( EACH OCCURRENCE --b—
<br />R, 000, 000
<br />AGGREGATE
<br />S,w 81000,1000
<br />1 D 0. � X � RETENTION$ 30 000
<br />115
<br />WORKERS COMPENSATION
<br />)
<br />'1
<br />I
<br />X STATUTE E
<br />AND EMPLOYERS'LIABILITY Y/N
<br />I
<br />I
<br />i
<br />_
<br />} -`------
<br />Is
<br />ANYPROPRIETORIPARTNERIEXECUTIVE
<br />ANY
<br />�`NIAC
<br />I
<br />3
<br />E5,L EACH ACCIDENT
<br />...500 000
<br />E.L DISEASE EA EhIPLOVEE'$
<br />_. _5OOr000'
<br />IOFFICERIMEMBER EXCLUDED?
<br />C In NH)
<br />1
<br />I IFICVH3069497-0-15
<br />l i
<br />5/_/2015
<br />5/1/2016
<br />.(Mandatory
<br />Ifyyes, describe under
<br />a
<br />500,000
<br />OESCRIPTIONOP OPERATIONS below
<br />I.
<br />I"-. 'i
<br />-
<br />El, DISEASE -POLICY LIMIT
<br />$
<br />D Professional Liability
<br />€
<br />BPM -DP 00303-00
<br />1/28/2016
<br />5/1/2017
<br />Limit 3,000,000
<br />DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required)
<br />The certificate holder is listed as additional insured with respects to the General i bil' as required
<br />by written contract.
<br />Odd.
<br />psemelsberger@santa-ana:or
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Attn: Police Dept ACCORDANCE WITH THE POLICY PROVISIONS.
<br />P.O. Box 1981
<br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE
<br />Kyle O'Malley/STANNI
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />IAICMC romnm
<br />
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