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CCIl V CERTIFICATE OF LIABILITY INSURANCE
<br />1015E(MMI dIYYYY)
<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(ies) 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 endorsements .
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. Inc. LIC # 0726293
<br />505 N Brand Blvd, Suite 600
<br />NAME: Mei Chan
<br />P " °NE 818 -539 2300 FAx 818 -539 -2301
<br />EMAIL ,Mei Chan a com
<br />_ @ Jg•
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 9
<br />Glendale CA 91203
<br />INSURER A: River ort Insurance Company
<br />36684
<br />10/112015
<br />INSURED
<br />INSURER B ;New York Marine And General Insuran
<br />16608
<br />Interval House
<br />P.O. Box 3356
<br />INSURER C
<br />Seal Beach, CA 90740
<br />INSURER D
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$100,000
<br />MED EXP (Any one person)
<br />INSURER E
<br />€ NSURER F
<br />Prof Liab.
<br />COVERAGES CERTIFICATE NLIMBFR. 253623936 RFVISInN NIIMRFR•
<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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />IN SD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MMIDDIYYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />RIC00147888
<br />10/112015
<br />1011/2016
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE ❑ OCCUR
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$100,000
<br />MED EXP (Any one person)
<br />$5,000
<br />X
<br />Prof Liab.
<br />X
<br />Sexue1MisrQnduct_
<br />PERSONAL & ADV INI
<br />$1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY JE �
<br />1-1 [::] LOG
<br />GENERAL AGGREGATE
<br />$3,000,000
<br />PROOUCTS - COMP/OP AGO
<br />$3,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />MI
<br />Ea accident
<br />$
<br />BOD {LY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY Per accident
<br />( )
<br />$
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />$
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />REL0014789
<br />10/1/2015
<br />10/1/2016
<br />EACH OCCURRENCE
<br />$2,000,000
<br />AGGREGATE
<br />$2,000,000
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED X RETENTION $0
<br />$
<br />g
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOWPARTNEWEXECUTIVE
<br />OFFICEWMEMBER EXCLUDED? N
<br />NIA
<br />WG201500005078
<br />1112015
<br />11/2016
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE- EA EMPLOYE
<br />$1,000,000
<br />(Mandatory In NHI
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT 1
<br />$1,000,000
<br />A
<br />A
<br />Crime /Employee Theft
<br />Forgery & A €teration
<br />RIC00147888
<br />RIC00147888
<br />101112015
<br />10!1!2015
<br />10/112016
<br />10/1/2016
<br />Deductible: $1,000 300,000
<br />Deductible: $1,000 200,000
<br />DESCRIPTION OF OPERATION51 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required}
<br />Carrier A: Blanket Building Coverage Limit: $4,339,2001 Special Form 1 Deductible $1,0001 effective 10 -01 -2015 to 10 -01 -2016
<br />Carrier A: Blanket Business Contents Limit: $530,000 / Special Form 1 Deductible $1,000 I effective 10 -01 -2015 to 10 -01 -2016
<br />Contract # 2012 -050. City of Santa Ana, its Officers, agents, employees and volunteers are named additional insured with respect to the
<br />General Liability policy of the named insured. Such insurance is primary and non - contributory. CG2026 Endorsement attached. Waiver of
<br />See Attached...
<br />CERTIFICATE HOLDER CANCFI I ATIAN
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Community Development Agency
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Terri Eggers
<br />�. y
<br />20 Civic Center Plaza, M -25
<br />Santa Ana CA 92701 USA
<br />AUTHORIZED REPRESENTATIVE
<br />� 4� ")
<br />©1988 -2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
<br />
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