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jv-Zo /s=I ?� DRMAU -1 OP ID: C6 A . OF LIABILITY INSURANCE 16 DATE(M as11712o7120 1 6 I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Wan ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brakke Schafnitz Ins. Brokers License #OK07568 Wilshire Blvd. 94 NAMECT Carole S. Mitchell PHONE 310- 524 -1357 aie, No :949- 313 -3323 Arc Na E E -MAIL ADDRESS: Carole.mitchell @sig.us 9 4401 1 Sa nta Monica, CA 9 Santa Darla Gray INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Lines Ins INSURED Dr. Maureen Sassoon P O Box 2028 Palos Verdes Peninsula, CA 90274 INSURERB: EACH OCCURRENCE INSURERC: CLAIMS -MADE OCCUR X X INSURER D: 0710112016 INSURER E : PREMISES Ea occurrence INSURER F; X COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DL UBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X X 624270427005 0710112016 0710712077 PREMISES Ea occurrence $ 50,000 X Add'I Insured MED EXP (Any one person) $ 5,00 X Prof & Pollut -CLM PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY 1 PRO- 71 LOG JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE UED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE PER TH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ It yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liab. G24270427005 07/01/2016 07101/2017 Prof.Liab 1,000,00 A Contractors Pall. G24270427005 0710112016 07/0112017 Pollution 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1a1, Additional Remarks Schedule, may be attached if more space Is required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable Endorsements Attached where required by Written Contract -E mailed to: SMorales5@santa- ana.org CERTIFICATE HOLDER CANCELLATION CSANTAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Briza Moraies,Risk Mngr P.O. BOX 1988 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD�