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11„ Policy Nurnber:605503396 Date Entered:12/7/201.5
<br />ACOORV
<br />DATE (MMY�DIYYYYI
<br />CERTIFICATE OF LIABILITY INSURANCE 12/7/2015
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terrns 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 endorsornent(s).
<br />P'RooulaER 196 Technology rcanr"�sE: Mike �trtd �.I k
<br />Mike ttodgick Insurance '� ., _ ..
<br />ology Drive, Suite B (AIP-�l^#k.E, Il, (`D5)^i5S.9555_"_"_..,..... Jaac,"Nal: (94tD) 753-9559
<br />EMAIL .... _.
<br />Irvine, CA 92.618 ADDRESS;_
<br />INSURED Santa Ana Business Council, Inc,
<br />Carlos Madriles
<br />400 E. 4th Street
<br />Santa Ana, CA 92701
<br />INSURER(S) AFFORDING COVERAGE NA4C p
<br />I
<br />INSURER A :Fasters Insurance Exchange _._ .. �21.652
<br />INsuRERB;StatEs Compensation InsurancFund 135076
<br />INSURER C . "frav.....elElrs _ ...... e 31194
<br />COVFRAnFS rFPTIFIr..'ATB NIIRMPIPP cat=t,rlclE" M I'll 1"Q9=ca.
<br />THIS IS "rO CERTIFY THAT THE POLICIES OF INSURANCE, LISTED BELOW HAVE BEEN ISSUED TO THE INSURED
<br />NAMED ABOVE FOR
<br />THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY R5QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER.
<br />DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED
<br />HEREIN IS SUBJECT
<br />TO ALL THE TERMS.
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR .. TYPE OF INSURANCE . ............ {AD[SLISuRR ..POLICY NUMBER MMIDDdIYYYY .fNDD/YYYY
<br />i �
<br />........ ...-LIMITS
<br />_.. _ ...
<br />j COMMERCIAL GENERAL (LIABILITY j
<br />,51i�+4-8.?ebr ! OCCUR l'4. f F.,,a�..�"k,,i' iN1 9 71,2✓Ib'7/2QY£� ,2/IJ7/2kki&
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />S1,000,000
<br />� �. . .. , _
<br />0 000
<br />I
<br />r r _
<br />o
<br />MED EkR (Ally C341L RC1r5en),
<br />I S 1D 000
<br />I
<br />PERSONAL & ADV INJURY
<br />� E 1 000 , 000
<br />tl ENLAI,GRCrmAI r LIMIT APPLIES PER
<br />GENERAL AGGREGArF,
<br />s2,000,000
<br />PRO-
<br />J5 cT L ti,
<br />PRODUCTS • COMPIOP ACC,
<br />,...
<br />s 1 000 000
<br />QTHER- I
<br />S
<br />AUTOMOWLE
<br />LIABILITY �...
<br />605503396
<br />2/07/2p15�2/17/2416
<br />i
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY (Per
<br />000a
<br />000
<br />1s1,_
<br />htEL•IVOVV"1D SCIDULELAuu (ASA{J,o5 (
<br />'.
<br />IUNiVIdC
<br />�.!
<br />RercaiblAUC
<br />...... _.
<br />BOL 1luY INJURY RW (Per ❑ecid n1}
<br />tif�ANr1AGE
<br />h i
<br />-RCCAUTOS \1AUTOS
<br />6#�cckT�dTaWntDl _
<br />S
<br />"
<br />I
<br />!
<br />UMBRELLA LIAR I OCCUR
<br />.._..._
<br />1
<br />EACH CCC RRENCF
<br />S
<br />EXCESSLMB CLAIMS' MADE'
<br />AGGREUA rE
<br />S
<br />aEu RETENTION s
<br />WORKERS COMPENSATION .I �..... {
<br />� RER 1 OTH,
<br />AND EMPLOYERS` LIABILITY YIN,:.
<br />STAT UJtI- - ER
<br />"
<br />ANY RI'dC)�ItIE:TCT�,lWAHTIIIiTiIc"„ I',2;r11'14YEa '�- � �. ,.o �, il2'/1i7/2Ct15 'L2/1p"f2t116
<br />0 h1CF:r MEMMER EXCLUDED? NIA
<br />E L EAM-1 ACCIDENT
<br />$ 1, 000 , 000
<br />... _
<br />fWBaedaCosr In
<br />E L_ DISEASE - EA E.Mi'�0.mdl"fcE
<br />Uoel�alelS1,000,000
<br />1
<br />C rSCl21w'TIG:9�1 CE QRE.RA'I'IDh151*wlc,,}rr s I 7
<br />1 E L- OI:SEASE - POLICY LIMIT
<br />.. ...
<br />i S1,000,000
<br />C Fidelity Bond I106032811 112/07/2015 L2/07/2016
<br />15,000 SIR
<br />500,000
<br />C D&O 1106032811 12/07/2015 12/07/2016
<br />1,000 SSR,
<br />1,000,000
<br />C EP 106iD32'$11 �2/47/2015 12/07/2016
<br />l 000 SIR
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS d VEHICLES (ACORO 101, Additional R.ernasks Schedule, may be attached If more space Is regWrod) ;ey
<br />The City of Santa Ana, its officers, agents and employees are named as additional insureds for
<br />General
<br />Liability purposes.
<br />CERTIFICATE HCII_r]Fk" r ANr` I I ATIriN
<br />City of ,Santa; Ana,
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />20 Civic Center Plaza
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />Santa Ana, CA 92702
<br />.1?.'ttn:. Risk Management _. Briza Morales
<br />AUTHORIZED REPRESENTATIVE
<br />C.�
<br />I
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