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Policy Number°, 605503396 Date Entered: 12/7/2014
<br />ACCMV CERTIFICATE LIABILITY INSURANCE
<br />r12 /ATE 12f77IfAIakIT)OPYYYa;
<br />/2014
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPONTHE 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(l'es) 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 />PRooUCER CONTACTMike Rod s.ck......
<br />146
<br />Mike Techngick Insurance NA 'PHON(9
<br />a5 .5._.,
<br />ology Drive, Suite a E-MAIL 99i73 9555 �ac,rlI.{9491753 5559
<br />Irvine, CA 92618 ntabREss:
<br />INSURERA:Farmers Insurance Exchange 121652
<br />INSUREU S a nta.. Ana Business Council, Inc. II4SiURER8:State CosmpensatioIp Insurance Fund 35076
<br />Carlos Madriles INSURER C:Travelers ;311.94
<br />400 S. 4th. Street INSURErIo _ _
<br />Santa Ana, CA 92101
<br />INSURER E:
<br />�ITiT►fT7sTrTrF w1i 1.4 11 rd KiNtmill M111]IICIAs T1AwikI[rTZ111116Td:i-d.
<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 />IND1CArED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF .ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED Oil MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT' TO ALL THE T RNI S,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS St -TOWN MAY HAVE BEEN
<br />REDUCED BY PAID CLAIMS.
<br />IkISR ._ _m_,.,w.._.. __......... ........ Abe tbibft'
<br />LTR 'TYPE OF INSURANCE � N � b POLICY IdUMOER
<br />POLMYTEdF "POLICYEXP
<br />MMdb'bMYYY MMitlrb/arYYY . , ..� ...,„„ . LIMITS... .
<br />p,
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<br />COMMERCIAL GENERAL LIABILITY
<br />...,. a �-"
<br />EACH OCCURRENCE $1 , 000 000
<br />_ .......
<br />"s.•
<br />'J"i
<br />CLAIMS -MADE �
<br />C `MADE i OCCUR �
<br />._._.�_._. �.`wJ �"'�
<br />606503396
<br />2/07/2014
<br />2/0"1/2015
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<br />IUV UC10
<br />PREMISS_I�aoccwrrrrsaop $+ .
<br />MFb E CP IAray umu Pc rrsun} ;10 000
<br />__... ? ................ .. .... _.
<br />PERSONAL & ADV INJURY S 1, 000 000
<br />,.0O,
<br />CR:GR CAPPLIES Ccik
<br />�^iNERALAGGRCDAT& I
<br />0f.00}.
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<br />OTHER
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<br />AUTOMOBILELMEIL1TY
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<br />60550339
<br />2/07/2014
<br />2.107/2015
<br />COMBINEE) SINGLE LIMIT
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<br />f9G1fSC1YNNIUIEY(Per
<br />$ 1 r n 000 000
<br />$
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<br />Person)
<br />ALI O)PINEl SCHEDULED
<br />i AGrTOS AUTOS
<br />BODILY+I IIURYIPrdr icgirlrarli➢
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<br />NON•OWNEL> -
<br />„ IdRk'tG L'F AV)1'G a ,� \ AUTOS
<br />PROTrERTY DAIrIAGE.
<br />UMeREILALIAB OCCUR
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<br />EACH OCCURRENCE
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<br />I XI.ESS LIAR QLa MIS M D
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<br />P irEC I RETENTION S
<br />CGMPENSA7YbN r
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<br />AND EMPLOYERS"LIABILITY YIN-
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<br />OfFICERIMEMSEREXCLUDED7 ;NIA;
<br />9081384-2014
<br />a.2i1.LY/2£'D7.�I 2i10/2,bfl5 F L'e'hl.'F6AC.GIG7�RIS 51,000,000
<br />, "..." .__ .__....,....
<br />I
<br />, INi
<br />(.�Idanr2aluri in � NH)1 }
<br />I E L DISEASE, E: EMPI OYEEr S 1, 000, 000
<br />if y dla,"Rb a under
<br />DESCRtPTIOIT OF OPERATIONS Ybel aw
<br />i
<br />.._. ........._.. .. , _
<br />1 El DISEASE -POLICY LIMIT I 31,000,000
<br />C !Fidelity Bernd 106032811
<br />12/07/2014 t2/07/2015 15,000 SIR 500,000
<br />C I D&O 106032911
<br />12/07/2014 12/07/201.5 1,000 SIR 1,000,000
<br />C E1' 106032t311
<br />12/07/2014 L2/07/2015 !1, 000 SIR 1,000,000
<br />bESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Re rnar*.n Schedule,
<br />may be allached H neare space Is required) %
<br />The City of Santa Ana, its officers, agents and employees are named as additional insureds for Oda oral
<br />Liability purposes.
<br />City of Santa Ana I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELRIERED 1N
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa .Ann, CA 92702
<br />Attn: Risk Management: - Briza Morales AU11TORVEDREPRESENTATIVE
<br />108R.W)irt AC:ORTT i:CSPF+P],PATIONL All rinlOr rngpnocerl
<br />ACORD 25 (2014/01) The ACORD narno and logo are registered marks of ACORD
<br />F''rrurlax:eGl �am+"ry CCrrwv,a l3o ; Plws sttllw.var, es�nsnF rrrrie dHr,4 ,,,, wnrar to upatsree. aer I-e'uVali.'Ihifrp NiEi417i➢8I^i"iJ�7P
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