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CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
<br />6/16/2016
<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(les) 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 />PRODUCER NAMEA T DiAn'na Martin
<br />All -Cal. Insurances Agency PHONEo (916)784 --9070 FAx gs16��e4 -oysa
<br />....,..., (AIC, Not:
<br />EMAIL �.
<br />505 Vernon Street ADDRESS,dianna @all- calinsurance.com
<br />Roseville CA 95678 INSURER APj2R rofits'
<br />INSURED Insurance Allianea of 03,1845
<br />INSURERB:New York Marine & General Insurance 624196
<br />Southwest Minority Economic Aevelpoment Association MSURERC:Nor'th American Elite Insurance 29700A
<br />DBA: Southwest Community Center INSURER D:
<br />1601 West 2nd. Street INSURER E:
<br />Banta Ana CA 92703 INSURER F
<br />COVIPPAGIPR, Y`1=0TIC1f''ATC KI➢ 1a ➢19C[].I"r i C 7 71 Ac'a/v,l
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM' OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIdITH 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 />ADDL
<br />INSO
<br />SUBS
<br />WV0
<br />POLICY NUMBER
<br />POLICY JEFF
<br />MMPDDIYY
<br />POLICY EXP
<br />IYYYY)
<br />. -
<br />LIMITS
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />OHMAGE EN'r
<br />PREMISES (Ea occurrence)
<br />....'.
<br />$ 500,000
<br />A
<br />CLAIMS -MADE FXI OCCUR
<br />X
<br />LIQUOR LIABILITY
<br />X
<br />2016- 02312NPo
<br />3/25/2016
<br />3/'25/2017
<br />MEO EXP (Any ono Per -n)
<br />$ 20, OOQ
<br />1,000,000 1,000,000
<br />PERSONAL &ADV INJURY
<br />$ 1,000,000
<br />L AGGREGATE LIMIT APPLIES PER
<br />PRO- �
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN
<br />X
<br />7
<br />PRODUCTS - COMPlOPAGG
<br />$ 2,000,000
<br />POLICY LDG
<br />OTHER:
<br />PROFESSIONAL
<br />$ 1,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />come INED SINGLE Lf 17°
<br />Ea aceident)
<br />$ 1,000,000
<br />BODILY INJURY (Per Person)
<br />$
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />2016- 02312NPO
<br />3/25/2016
<br />3/25/2017
<br />BODILY INJURY Peraccidant)
<br />(
<br />$ _.m_....
<br />X
<br />x NOWOWNED
<br />HIRED AUTOS AUTOS
<br />COMP DR�D ,R 500
<br />Pe�pccld
<br />..,,...._..-
<br />tDAMAGE
<br />$
<br />COLL DED $ 500
<br />$
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE.
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />_
<br />X STAR ,E I ERH
<br />E.L EACH ACCIOENT
<br />...._.......
<br />$ 1,000,000
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICERI M1EMBER EXCLUDED?
<br />NIA ''
<br />R
<br />(Mandatory in NH)
<br />II yea, describe under
<br />WC 2016 0000 8673
<br />3/26/2016
<br />3/26/2017
<br />E.L DISEASE - EA EMPLOYE
<br />$ 1 000 000
<br />E.L. 015 EASE- POLICY LIMIT
<br />�� �.
<br />$ 11000,000
<br />UESCMPTION OF, OPERATIONS bsBow
<br />C
<br />EMPLOYEE DISHON $Ty
<br />CWS 0000 295 -14 02312
<br />3/25/2016
<br />3/25/'2017
<br />LIMIT 25,000
<br />FORGERY S ALTERATION
<br />DEDUCTIBLE 1,000
<br />DESCRIPTION OF OPERATIONS.I LOCATIONS I VEHICLES (ACORD 141, Additional Remarks Schedule, may be attached Ir more apace Is required)
<br />THE CITY OF ,SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES ARE NAMED ADDTIONAL INSURED,
<br />INSURANCE IS PRIMARY AND FORM CG 20 10 APPLIES
<br />THE CITY" OF SANTA ANA
<br />FINANCE & MANAGEMENT SERVICES AGENCY
<br />PURCHASING DIVISION
<br />20 CIVIC CENTER PLAZA M -16
<br />P.O. BOX 1986
<br />SANTA ANA, CA 92702
<br />11#At1 P=LLH I IU N
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Q 1988 -20114 ACORD CORPO RATIO N,_AW rights reserved.
<br />F%%, mu AD kAU14IU1I ) he ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />
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