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DATE (MMIDONYYY1
<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(les) 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 fled, of such endorsement(s),
<br />PRODUCER GarretUMosier/Griffith/Sistrunk NAME CT
<br />Risk Management & Insurance Services PHONE Ax
<br />12 Truman 4G. NP. BAD (949)559-6700 AIC No) . _ (949)559 6.703_
<br />Irvine, CA 92620 po cress
<br />www gmgs com 0984519
<br />_ ........ _____ __.__ ...,
<br />INSURER A'
<br />Peerless Insurance Company
<br />241`96
<br />. _................
<br />INSURED
<br />INSURERS:
<br />Golden Eagle Insurance Company_
<br />10835
<br />Superior Property Services, Inc.
<br />INsuaea c:
<br />Cypress Insurance Company
<br />10855___
<br />9129 Perkins St.
<br />CLAIMS -MADE ,yA_OCCUR:PREMISES{Eaoccurtence},_
<br />..._,
<br />100,000
<br />....____
<br />Pico Rivera CA 90660
<br />INSURER D:
<br />5,000
<br />__........
<br />PERSONALfl ADV INJURY S
<br />INSURERE
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />V J
<br />NSURERF:
<br />- PRODUCTS - COMPIOP AGO $
<br />2000,000
<br />CDVERAr;ES CFRTIPICATR NIIMR9R, vn RnT7ae
<br />S
<br />RPVIAIrTN NIIMRPRr
<br />B AUTOMOBILE LIABILITY BA8951133-
<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
<br />BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />wdbsk T_-.........._--AbDL 90OR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />POLiCI'�akk- pOLIC`'EXP_._ ... _�..
<br />MM DDfYYYY I D"Irf LIMITS
<br />A �/ COMMERCIALOENERALLIAWLITY --. CBP1091256
<br />6/22/2014 8/22/2015 EACH OCCURRENCE '', S_
<br />1,000,000
<br />CLAIMS -MADE ,yA_OCCUR:PREMISES{Eaoccurtence},_
<br />DAMAGE TO -RENTED s
<br />100,000
<br />....____
<br />✓ 525.O -Deductible
<br />. __... ..._..____.-_
<br />: MEDEXP(Anycneparem) s
<br />_.1....... ...S
<br />5,000
<br />__........
<br />PERSONALfl ADV INJURY S
<br />..-- 000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE S
<br />2000,000
<br />POLICY PRO LOC
<br />ECT ,
<br />- PRODUCTS - COMPIOP AGO $
<br />2000,000
<br />OTHER:'
<br />S
<br />B AUTOMOBILE LIABILITY BA8951133-
<br />'.6/22/2014 ,6122/2015(OMctleDYINGLE LIMIT `S
<br />1y00�„OOQ
<br />✓. ANY AUTO
<br />BODILY INJURY (Per person)'$
<br />ALLOWNED SCHEDULEDBODILV :
<br />AUTOS AUTOS
<br />INJURY .......
<br />IPerawitlanQ 5
<br />✓IHIREDAW05 ✓_A�TOSWNED $500 Coll. Ded
<br />,�PeSsccRtleYEDAMAGE
<br />_..
<br />_
<br />.$500 Comp Ded
<br />3
<br />UMBRELLA LIAR ! OCCUR
<br />EACH OCCURRENCE S
<br />EXCESSLIAB 1 CLAWS -MACE ''..
<br />AGGREGATE 3
<br />OED _ RETENTIONS
<br />^>:
<br />C WORKERS COMPENSATION ',3300061722-141
<br />6/2212014 6122/2015TH
<br />✓ 9R
<br />AND EMPLOYERS' LIABILITY
<br />STATUTE,, __,
<br />ANY PROPRIETORIPARTNERfEXECUTIVE
<br />E L EACHACCIDENT 5
<br />1,000,000
<br />'�YIN
<br />OF510ERIMEMSM EXCLUOED? NIA
<br />(Mandatary In NH( J
<br />I E L DISEASE EA EMPLOYEES
<br />1,000,000
<br />Iryes, deecdbe under i-'--
<br />IDESCRIPTIONOFOPERATIONSWow
<br />'. El. DISEASE POLICY LIMIT IS
<br />-'-
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS !LOCATIONS I VEHICLES iACORD 101, Additional Remarks Schedula, may be attached if more space is required)
<br />As respects General Liability coverage, City of Santa Ana, its officers, employees,
<br />agents, volunteers and representatives are added as Additional
<br />'FQ��
<br />Insureds and this insurance Is primary, per GECG 970 (01/11) attached.
<br />P's TO
<br />_--
<br />%g�pPRO'VED
<br />Clerk of the Cit Council SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City Of fthe Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Y ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza (M-30)
<br />P.Q. Box 1988 ----
<br />Santa Ana CA 92701-1988 AUTHORIZED REPRESENTATIVE
<br />Michael. Finn
<br />© 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />cear ae., IiY,11a1 rcamo :sera a_3o:aa am 'PET Page I If
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