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<br />CERTIFICATE OF LIABILITY INSURANCE
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 'PERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />��IY
<br />4/10/2015
<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 tho cortiflcoto holder Is an ADDITIONAL. INSURED, the policy(ies ) must be endorsed, If SUBROGATION IS WAIVED, aubjeat 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 />cortificate holder In lieu of such ondorsomont s .
<br />PRODUCER
<br />G
<br />NA.MEI DiAnna Marten
<br />...___
<br />A11 -Cal Insurance Agency
<br />.... _._ ....,..
<br />,j(+C4 t (916) 784 9G 70 ��� NA),..,(A161 Ee4 -0155
<br />_ .._ -.
<br />505 Vernon Street
<br />........
<br />EMAIL
<br />- diauna @411 calirtavranca. com
<br />..) CLAIMS -MADE I %_� OCCUR
<br />AFFOMlNG COVERAGE NAICN
<br />RdaeV111a GA 95678 ,. -.
<br />_..- ....._ _. ... ._. . __ ., .... . .. ... ... ... ..._,.... ....
<br />INSURI'R,A NDY1 'arQ 1't.9,',- Insuran;A43- tll.lanCe O%' 011845
<br />.. .. ._._..
<br />INSURED
<br />_..
<br />INbURLRB New Xork Marxno 6,Ganzral Insurance 624A95
<br />Southwest Minority Economic Derrelpoment Association
<br />. INSURERCNorth _b)msasigazz,F1i.,tu Instlranee 2970OA
<br />DHA: Southwest Community Centel"
<br />. INBUgCR__ D,,, i-_.__..._..._...._...,,....._
<br />1601 West 2nd Street
<br />.............._.....__.._..._._.......__..._...... ......- .....- ._................ ....._...._._-......__-,,.._.-
<br />.........:..._....... . ..... ..... ....__...-
<br />Santa Ana CA 92703 1
<br />...... ....
<br />INSURER
<br />COVERAGES CERTIFICATE NUMBERICL1532704415 REVISION NUMBER:
<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, 'PERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PER'T'AIN, 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 />)... 8'N ......_.- ...._.._... IKHPL SU9R ..............__._.._.. ._— .....�___.___.__._..__..._'T "POLICY EPF -] POLICY.,._ -P_j ..__...-.._..,.......,_...__.............._........... ._........_......... „.._...._..
<br />L TYPE OF INSURANCE LICYNUMB' M /D M/b LIMITS
<br />_
<br />COMMEROIALGENERAI. LIABILITY
<br />_ '
<br />EACH OCCUuRRENCE .. ,.
<br />B 1x000,000
<br />_500,000
<br />A
<br />..) CLAIMS -MADE I %_� OCCUR
<br />onMiCd @'ti'd Fi"EN'PEO
<br />.P_8.0MIEU.S LEd, RQpIDW0A5).._
<br />$
<br />X
<br />PAOLENSxLq AL ,.1IN„6,SLTTY.__.
<br />X
<br />2015- 0231214PO
<br />3/25/ 2015
<br />V25/20Y6
<br />-M90 EXP (A oned]araonj._....�.-
<br />$_..... 20,000
<br />$, -]r 0008000 - [.1x000, 000,,,
<br />PER$ON ?L BADV INJUSV
<br />$ 1,000,000
<br />GENL
<br />AGGREGATE LIM IT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 2,006x000
<br />POLICY .,_..� JECT L._..I LOO
<br />PRODUCI'8- _90MPIQPAGa,
<br />2
<br />S 60tlx000.
<br />OTI1E
<br />LIQUOR LIABILITY
<br />$ 1,000,0130
<br />AUTCNfOEILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />fFa.d9r,LM�U
<br />$ 1 POOr000
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />}$
<br />A
<br />_
<br />AUTO NW AU70SU46D
<br />12015- 02312NPC
<br />3/25/2019
<br />3/25/2016
<br />BODILY INJURY(Por ac old ent)I$
<br />_.. .,
<br />X NUN -OWNED
<br />HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />....
<br />$
<br />F
<br />UMBRELLALIAB OCCUR
<br />I
<br />OC W RRENOE
<br />-- ._._.. .._._.._._...__..._.........
<br />$ -.. ......... , ..............
<br />I
<br />EXCESS LIAR CLAIMS -MADEi
<br />I AGGREGATE
<br />$
<br />DEG RET NTION$
<br />$
<br />PER OT
<br />STATUTE gR
<br />ANY F,MPLUYFR3'6IABILITY
<br />AND EMPS YERS'LIAILIT
<br />YLNi
<br />-_ ____..
<br />ANY PROPRIETOR/PART001207 ECUTIVE `
<br />OFFICEtoryin
<br />NIA
<br />LL EACH ACCIDENT -- -'
<br />8 ,7,000 000„
<br />^;
<br />B I
<br />H)6XCLUpEU?
<br />(Mandatory in NN)
<br />wiC 2015 0000 8673
<br />3/26/2015
<br />3J26/2016
<br />EL DISEASE EA EMPLOYE
<br />$ 71000,000
<br />If ea describe under
<br />0 E Im'IU OF OPERATIONS below
<br />I
<br />E,L DISEASE- POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />EMPLOYiE DISHONESTY
<br />CNS 0000 295 -1.3 02312
<br />3/25/2015
<br />3/25/2016
<br />LIMITS 25,000.
<br />E'OAG,ERy 5 RT,TFRATION
<br />�
<br />DEDUCTIBLE - 1,000
<br />�
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VC.IdICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is requlredi
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPIOY.EES, AND VOLUNTEERS ARE NAMED ADDITIONAL h
<br />INSURED AS A FUNDING SOURCE, PRIMARY WORDING, SEVERA)BILITY OF INTEREST, AND FORM CG 20 26 APPLIES,
<br />CITY OF SANTA ANA.
<br />A.TTN: FRANK HERNANDEZ
<br />20 CIVIC CENTER PLAZA, .M -•25
<br />PO BOX 1988
<br />SANTA ANA, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLCD BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BB DELIVERED IN
<br />ACCORDANCE WI'T'H THE POLICY PROVISIONS.
<br />ALITHORIjED REPRESENTATIVE
<br />WV/ E
<br />©'1985201
<br />ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
<br />I NS025 (201401 )
<br />reserved,
<br />V1
<br />
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