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A '2
<br />ACOWL? CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY)
<br />8/30/2016
<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(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 endorsement(s).
<br />PRODUCER CONTACT
<br />L
<br />NAME: Laurie m
<br />e Geroetta
<br />Hayward Tilton & Rolapp Insurance Associates, Inc. fAPHONE FAX M.Na.,,,: (714)905-1923 ol (714) 905-1910
<br />---- LfAiCAN,
<br />CA Dept. of Ins. Lic. #0614365 E-MATL I
<br />ADDRESS: auri eg@ h trin sure. coo
<br />888 S. Disneyland Dr., Ste 400 INSURER(§J FFORDING COVERAGE NAIC #
<br />Anaheim CA 92 802-184 6 INSURERA:Sentinel Insurance C a y LTD 11000
<br />— - ----- . ......
<br />INSURED INSURERB -Hartford Accident &.,Inde=ity 22357
<br />ID Modeling, Inc. INSURER 0 Admiral Insurance Co 24856
<br />55 E Huntington Suite 13,0 INSURER D,
<br />INSURER E
<br />Arcadia CA 91006 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER 716- 17 PL GL Auto RFVI-ql'nhJ MIIMRI=P-
<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 ADDL�SUBR� POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIODNYYY) LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />CCURRENCE 1,000,000
<br />A
<br />"IMS -MADE X OCCUR
<br />_EAqH.
<br />DAMAGE TO RENTED 0
<br />PREMISESLE8 occurrence) 1,00,000
<br />x
<br />72SBAAJ7706
<br />1/6/2016
<br />1/6/2011
<br />MED EXP (Any one parso n) $ 10,000
<br />PERSONAL & ADVINJURY...-
<br />$ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GFN'L AGGREGATE LIMIT APPLIES PER:
<br />PRO -
<br />F7 E
<br />POLICY JECT LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />IOTHER�
<br />AUTOMOBILE LIABILITY
<br />a accid..eNE0__ Z '
<br />IECOMBIDtJ..SINGLE LIMIT 1,000,000
<br />B
<br />ANY AUTO
<br />BODILY INJURY (Per person) $
<br />ALL OVINED SCHFDULFD
<br />AUTOS AUTOS
<br />72UECPX8358
<br />1/6/2016
<br />1/6/2017
<br />BODILY INJURY( Per accident) $
<br />NON -OWNED
<br />HIRED AUTOS
<br />PRbP'ffRTY DAMAGE $
<br />AUTOS
<br />_(EgEgccident�
<br />Uninsured Motorist combined $ 1,000,000
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />$
<br />EXCESS LAB
<br />CLAIMS -MADE
<br />DED RETENTION
<br />$
<br />WORKERS COMPENSATION
<br />PER OTH-
<br />AND EMPLOYEIRS'LIABILITY YIN
<br />_rLSTATUTE I I FIR
<br />ANY PROPRIETORiPARTNEREXECL)TIVE
<br />OFHCERIMEMBER EXCLUOED9
<br />NIA
<br />FLLL EACH ACCIDENT
<br />(Mandatory in NH)
<br />F L 06EASE - EA EMPLOYE
<br />$
<br />If yes, under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT �
<br />$
<br />C
<br />Professional Liability
<br />E000002663203 8/30/2016 8/30/2017
<br />PerClalrn $1,000,000
<br />Deductible$25,000 per claim
<br />Retroactive date B-30-2004
<br />Policy Aggregate $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1 Or, Additional Remarks Schedule, may be attached if more space is, required)
<br />If recruired by written contract, Certificate Holder and its agents, officers and employees are Included
<br />as Additional Insureds and Primary/Non-Contributory wording applies as respects General Liability per
<br />Endorsement Form SS 00 08 04..05 attached.*CANCELLATION: 10 -days Notice for Non -Payment of Premium and/or
<br />Non -Reporting of Payroll or 30 days for all other reasons,
<br />The City of Santa Ana; its officers,
<br />employees,agents,volunteers and
<br />representative
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92704
<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 />Laurie Gerometta/LKG
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014101) The ACORD name and logo are regiistered marks of ACORD
<br />INS025 0014011
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