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CERTIFICATE LIABILITY
<br />5r'DATE t WDDIYYYY)
<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 />BELO'w. THIS CERTIFICATE OF INSURANCE, DOES NOT CONSTITUTE. A CONTRACT BETWEEN THE ISSUING INSURER1Sj, AUTHORIZED
<br />REPRESENTATIVE, OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate hoider 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 doses not confer rights to the
<br />certificate holder in lieu of such endorsernent(s).
<br />PRODUCER
<br />Crystal & Company
<br />CISC Insurance Services LLC
<br />32 Old Slip
<br />New York NY 10005
<br />INSURED_ ..
<br />Palermo TT Holdings, Inc
<br />9477 Waples, Smite 100
<br />San' Diego CA 92121
<br />�a�tP" ,Jonathan Thomas
<br />(A/C,NNo,Extl. 415-045-7500 iArC:.Nof 415 046 7a50
<br />1a5 cr stalco.com
<br />ADDRESS, i olnatltan tt7OITy
<br />INSURERISI AFFORDING COVERAGE NAIL 18
<br />INSURER A:Indlan Harbor Insurance Company 35040
<br />TTHOLD
<br />INSURERS Valley Forge Insurance Company 20508
<br />INSURER :National Fare Insurance Company of 20478
<br />...Company
<br />INSURER D�Ccntlnental Casualty ..... 2C443
<br />INSURER E
<br />r..rt\It=0AnI=Q n'9=RTMtrA,Tr_ Nil lnM4MPID- I7iiAdrC i791I , 01=111cie`eai Nil vaaczcD-
<br />THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED 19EI 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 CONDITION'S OF SUCH POLICIES- LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
<br />INSR ADEL SUBR .... _._.. POLICY EFP POLICY EXP
<br />TYPE OF INSURANCE
<br />LTR _ _ INSD WVD POLICY NUMBER: MMIDDlYYYY MMlODfYYYY
<br />LIMITS
<br />P X COMMERCIAL GENERAL LIABILITY 6024533045 5I1/2016 5/112017
<br />FACHOCCCURRENCE $1,000,000
<br />CLAIMS -MADE X OC'ICUR
<br />DAMAGE TOR NTEG.....
<br />PRPASES.Ea31,000000.....
<br />MED EdP (,Arty one pereum) 315,000
<br />PERSONAL M ADV INJURY .S1.000,000
<br />..S2,000,O�00
<br />GEr L AGGhFE'3A7E LIMIT APPLIES PER
<br />GENERAL A0,GPEGATE
<br />JECT X L 01 -
<br />PRODUCTS - COM PIOP AGG S2,000 000
<br />C AUTOMOBILE LIABILITY 53
<br />6024,i�3a5£h/1r2,r�16 5r1re rr1 r
<br />l'INC,LE LIMN
<br />• '1,saa,u2r1
<br />`Ea
<br />a< �iJFC,
<br />X ANY AUTO
<br />PODIL'( ILUURr (,P,?r pars+om
<br />K AULC7SfhuHLti ,x UT,',iCI
<br />BODILY INAJRY(Per,accident) S__....
<br />NON -OWNED
<br />X HIRED AiITJS X
<br />_.... __.. _......
<br />l�AhlVr Gp
<br />ptO '
<br />pRcdenf 1
<br />....'C_.
<br />X UMBRELLA LCAS X OCCUR 6024533093 5/1t20IS 5/1/2017
<br />LACH OC'CAJRREN(,E 510,000,0010
<br />EXCESS LIAR CLAIMS -MADE
<br />4f3Gk.EC,4rE *10,000.00:0
<br />DED RIETENTION,5
<br />C1 WORKERS COMPENSATION 5024533076 - 5/1/2016 5/II2017
<br />X PER CTH.:
<br />D AND EMPLOYERS' LIABILITY Y/N 6024533062 511/2016 5f 1/2017
<br />STATUTE Ef; _.
<br />A1V PRC7PRIETORY AR I NE 'R L(ECLTIVE ------'...
<br />E.I.. EACH ACCIDENT 11,000 000
<br />()FFICER'+MEMSER-XCCLUDED'v N r A
<br />(Mandatary Ira NH)
<br />E.L. DISEASE - EA EMPL.(DYEE 1;1,0001000
<br />If tnrler
<br />DESCRIPTiOri OF OPERATIONS below
<br />L_L CIS EASE POLICY LIMI T 31,000,000
<br />A Tech Professsnnal Llah MTP003220001 51112016 511/20/7
<br />5,000 000 Each Claim
<br />Retroactive Date 1/U102
<br />5.000,000 Aggregate
<br />Claims Made
<br />t00.000 Retention
<br />DESCRIPTION OF OPERATIONS I LOCATIONS d VEHICLES IACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />City of Santa Ali@ its officers, employees, agents volunteers and representatives is included as Additional Insured as required by written
<br />contract, but limited to the operations of the Insured under said contract, per the applucable endorsement with respect to the General Liability
<br />and Automobile Liability policies.
<br />4�, 4/
<br />I - CM I II -HA I t MULULK UANGELLA I IUN
<br />City of Santa. Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />60 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92701-0000,
<br />AUTHORIZED REPRESENTATIVE
<br />R "
<br />@ 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/0'1') The ACORD name and logo are registered marks of ACORD
<br />
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