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<br />INFOS-11 OP IID� KO
<br />--
<br />DATE (MMIDDNYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE � 11/2312015
<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 INSUREIR(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, ANDTHE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed., If SUBIROGATION' 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 />cMrtificate holder in Hou of such ondorspritf
<br />PRODUCER 'CONTACT
<br />NAME� Kevin K. O�'Connor
<br />Friedmann & _CxCA Friedmann Ins Svcs, PHONE 949'-253-8000 TAR
<br />9License #075373 _AJCNo, Ext I _c NoL. 949-263-8009
<br />39190 Westerly Place Suite 100 E-MAIL
<br />Newport •o
<br />Kevin K. O'Connor 1INSURER(S) AFFORDING COVERAGE NAIC N
<br />INSURER A Chubb Group of Insurance Co's
<br />INSURED INIFOSEND, Inc.
<br />INSURER 8 Axis Surplus Insurance Company 26620
<br />Renal and Soni, LLC
<br />4240 E. La Palma Ave
<br />: . ..... ... . . ..... . .. . ........ . ... ...... . . ....... . ..... .. ...... ...........
<br />Anaheim, CA 92807
<br />INSURER D :
<br />INSURER E:
<br />I INSURE F
<br />COVERAGES CERTIFICATE NUIII
<br />REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES
<br />OF INSURANCE
<br />LISTED BELOW HAVE BEEN
<br />ISSUED TO
<br />THE INSURED
<br />NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
<br />TERM OR CONDITION
<br />OF ANY
<br />CONTRACT
<br />OR OTHER
<br />DOCUMENT WITH RESPECT To WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY
<br />PERTAIN,
<br />THE INSURANCE AFFORDED BY
<br />THE POLICIES
<br />DESCRIBED
<br />HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH
<br />POLICIES,
<br />LIMITS SHOWN MAY HAVE
<br />BEER
<br />REDUCED BY
<br />PAID CLAIMS,
<br />-iNS§
<br />LTR TYPE OF INSURANCE
<br />ADOL
<br />inm-vyk
<br />SuBR
<br />POLICY NUMBER
<br />POLICY EIFF
<br />MMIDoryYy-Y
<br />POLICY EXP
<br />-MmmftdY=
<br />LIMITS
<br />A COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,0010
<br />CLAIMS -MADE 1XI OCCUR
<br />X
<br />36031149
<br />02/24120,15
<br />0212412016
<br />-D-A-MAGFTO RENTED''
<br />PRIEM SES..�Ea o ;9 re ce�, $ 1,000,0010
<br />� 2.M.— . ..... .. .....
<br />MEG EXP (Andy one person) $ 10,000
<br />PERSONAL & ADVINJURY $ 1,000,000
<br />.. . ...... . .... . . ..... . .. ....... ... .... .. ... ....
<br />- ----- --- - -------
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE_ $ 2,0010,000
<br />POLICY E—] PRO- LOC
<br />E--
<br />PRODUCT'S - COMP/OP AGO 2,000,000
<br />. ....... .............. .. ... . .. . ... . ........... ...... ....... . ..............
<br />$
<br />--]C,Tllll
<br />—IJLRC�
<br />AUTOMOBILE LIABILITY
<br />OOMBINIED SINGLE LIMIT $ i,000,000
<br />. 09
<br />-(E"P�q
<br />A
<br />ANY AUTO
<br />735871201
<br />0211812016
<br />0'211812016
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />AUTOS FX AUTOSDAMAGE
<br />. ....... . . ... ... .. . . ...
<br />BODILY INJURY (Per accident) $
<br />X NION-OWNED
<br />$
<br />HIREDAUTOS AUTOS
<br />1
<br />L
<br />(Pen accidenil .. ....
<br />$
<br />X
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACHI OCCURRENCE $ 5,000,000
<br />A
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />79896856
<br />0212412015
<br />0'212412016
<br />A GREGATE $ 5,000,000
<br />DED RETENTION$
<br />$
<br />KERS ENSATION
<br />-
<br />PER --
<br />XER
<br />AND EMPLOYERS* LIABILITY YIN
<br />A
<br />ANY PROPRI ETOR/PARTN ERIE XECUTIVE
<br />X
<br />71749812
<br />0210112015
<br />0210112016
<br />E.L E4GkiACCICENT $ 1,000,000
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />(Mandatory In NH)
<br />E L DISEASE - EA EMPLOYEE $ 1,000,000
<br />If es, sunder
<br />S6 describe
<br />I D RIPTION OF OPERATIONS below
<br />I
<br />I
<br />E L DISEASE - POLICY LIMIT $ 1,000,000
<br />B Errors & omissions MCN000222831501
<br />12/01/2016 12/01/2016, Limit 5,000,000
<br />Deduct 25,0100
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES ACORD 101, Additlorod Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, Caflforma
<br />9127011;
<br />its officers, employees agents, volunteers and representatives are
<br />hereby �.;
<br />named as an additional insured with regards to General Liability. Waiver of
<br />k
<br />subrogation applies to workers compensation.
<br />;
<br />I 0 L 0
<br />AP
<br />CERTIFICATE HOLDER
<br />CANCELLATION 1Z
<br />SAN2003
<br />�7
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE 'THEREOF, NOTICE WILL BIE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PO Box 111954
<br />Santa Ana, CA 92702
<br />AUTHORIZED REPRESENTATIVE
<br />C:1
<br />. .. . .... . ..... . . .....
<br />1988-2014 ACORD CORPORATION. Aril rights reserved.
<br />ACORD 26 (20141011) The ACORD name and logo are registered marks of ACORD
<br />
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