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t� �y , ° 7(nIM/pa/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 5/29/2015
<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. TI -113 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, sub]act 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 ROD of such endorsement(s),
<br />PRODUCER
<br />CONCT
<br />NAME
<br />SelectSolutlons insurance Services, LLC
<br />,� u. E.%tJ, 868,500 6359 tuc q;,,,.,555 804 84
<br />IACNe Pax 49
<br />"
<br />1350 Carlback Avenue
<br />@- R
<br />Walnut Creek, CA 94596
<br />P,
<br />rACHOCCURRCNCL
<br />.,,_,..., .... .. ..
<br />iNaUR@RISJ AFFglip{Nq COVERAI'AE MAIC #
<br />...... ...-
<br />INauREo
<br />_
<br />lrlsuRERA New,York-Marine, &, General_Insurance 16608
<br />Wise lace, a Ca Corpba WI60 Sliver Center
<br />p p ter
<br />IN6URERs Phlladelphla Indemnity Insurance Cgmpany 18058
<br />1411 N. Broadway
<br />IN611-RERC
<br />Santa Ana, CA 92706
<br />"" ..
<br />INSURER p
<br />.,NSII,R@R E: I
<br />........, . ............ ., ........ .,- .... .... _.,_.,,.....
<br />INSURER F . _.-.....r.
<br />COVERAGES - CERTIFICATE NUMBER: REVISION NUMFRFR- -.... __._
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LMTEO BELOW HAVE BEEN ISSUED TO THE IN5URED NAMED ABOVE FOR THC"-. POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO "11011 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
<br />PP(1,610D FF.". DMID YEkr�" " ."..'."". ,.. '...... .--""" "-. ..,••._,.,.,....
<br />LTR TYPE OFINSURANCE PODGY NUMaER MMlpp /ODfYYYY LIMITS
<br />GENERAL LIABILITY
<br />rACHOCCURRCNCL
<br />'$ 1000000
<br />✓ COMMERCIAL GENERAL LIABILI RY
<br />19AMAGH 1OlIEN Fn
<br />--
<br />GLAIMSMADE l ✓,..I OCCUR
<br />PREMI$E$(EW..QAGOFence)
<br />MCD C%P (Any ona PersanJ
<br />„� 60p0
<br />B
<br />f
<br />Yes
<br />PHPK1278336
<br />1/112015
<br />1/112074
<br />PERSONAL&ASV INJURY
<br />$ 1000000
<br />II
<br />.., .....,, ..., _,.,......
<br />OLNLRAI.AGGRC0A7G
<br />$ 2000,000
<br />r PN'I. AGGREGATE LIMIT APPLIES PER;
<br />PRODUCTS COMP/OPAGG
<br />$2000000
<br />jj.......
<br />✓ PIiO-
<br />.. _. .. .. ...$
<br />...............
<br />POLICY LOC
<br />AUTOMOBILE
<br />LIADILITY
<br />COMBINED SINGLE LIMIT
<br />$ 1,000,000
<br />✓
<br />ANYAUTO
<br />' (Eamoodent)
<br />BODILY INJURY(Gorpel'son)
<br />$
<br />✓
<br />ALL OWNED AD'I'OS
<br />Yes
<br />I
<br />IBODILYINJURY(Poreccldon)
<br />$
<br />B
<br />✓
<br />SCVI EDCLEDAUTOS
<br />I
<br />PHPKI279335
<br />1/112075
<br />111/2018
<br />PROPERTY DAMAGE
<br />$
<br />IIIREDAUTOS
<br />(Per acnldent)
<br />✓
<br />NUN -OWNED AUTOS
<br />$
<br />./
<br />UMaR a CA LIAR ✓ OCCUR
<br />CAUL OCCUHRCNCr
<br />S 1 U00 000 W,
<br />El
<br />C%cise LIAR CLAIMS MAGE
<br />'.. ...$
<br />�ADnRLGATE,-_,
<br />.--... _.,_
<br />7 060 000
<br />, ... - -1----
<br />Yes
<br />PHUB486326
<br />1/1,2015
<br />1/12018
<br />-,,,,,
<br />...... ..,...
<br />.,., m_UEpUCnaLE
<br />✓
<br />RETENTION $ 10,000
<br />$
<br />WORKERS COMPENSATION
<br />WC 6AU
<br />ANDEMPLOY6RS'LIAEILITY YIN
<br />'.TRBYLJMIT.._
<br />A
<br />ANY PROPRIETORIPARTNERIEXECUTIVE
<br />OFFICER(MEM$EREXCLUDED?
<br />N/A
<br />WC201400006533
<br />(1/75/2014
<br />811512016
<br />i L hAChI AGCIDI NT
<br />C --
<br />$ 1000000
<br />- ..-.... .....
<br />in
<br />olaH'A •,E-hA IMPLOYF,'E
<br />$ 1000000
<br />IfMy.Rd.tery
<br />t under
<br />.........
<br />........... ..........
<br />D[•:6C,RIP11MI OF OPERATIONS below
<br />F:.I..DISEA.___
<br />613 -POLICY hIMII
<br />$ 1,000,000
<br />a
<br />Professional UNNI8y (Errors and Omisslons)
<br />PHPK1278335
<br />1/1/2015
<br />1/112078
<br />$1,000,0001$2,000,000
<br />DESCRIPTIONOFOPERATIONS/LOCATIONS/VEHICLES (Atineh ACORD 101, Additional Remarks 0chndulo, If more spneo In required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Addltlonal Insured with respect to General Liability policy per
<br />attached endorsoment.This Insurance is primary and non-contributory to any other Insurance provided as respects General Liability policy per attached -1
<br />endorsement. The Prgfossional Liability Limits shown represent the Per ClaimlAggregate Limits of Liability,
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED RaPRESENTATIVIE
<br />roserved.
<br />
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