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ACQR�
<br />CERTIFICATE OF LIABILITY INSURANCEF9,/26%2016
<br />(DATE (MMIDD/YYYY)
<br />Ix
<br />WHICH THIS
<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
<br />CONTACT Robin Holloway
<br />Insurance Solutions
<br />H Fin,. til; (949)348-7400 FA1C,No):Isagy3ae-z31a
<br />..
<br />License X0746539
<br />•MAIL
<br />ADDRESS: RobinH@ins-solutions.com.
<br />_.
<br />33302 Valle Rd, Suite 200
<br />INSURER(S) AFFORDING COVERAGE NAIC1t
<br />San Juan Capistrano CA 92675
<br />..INSURED _. _
<br />INSURERA:The Ohio Casualty Insurance Company 24074
<br />_INSURER
<br />PERSONAL SADV INJURY $
<br />B Allmerica Financial Benefit 41840
<br />Profess;i,onal. Sports Field Maintenance Inc
<br />INSURER C; American Fire and Casualty Company 24066
<br />23 Emerald Gln d
<br />INSURER Io :State Comp _ins Fund 35076
<br />PRODUCTS-COMPlOPAGG $
<br />INSURER E:
<br />Laguna Niguel CA 92677
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:16-17 All REVISION NUMBER:
<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. NOTVATHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
<br />CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSRADDL'.SUBR
<br />LTR ''... TYPE OF INSURANCE ! POLICY NUMBER
<br />' ...POLICY EFF POLICY EXP ......... ...... _...
<br />,POLICY
<br />MMIDDIYYYY LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />,....
<br />I EACH OCCURRENCE $
<br />1,000,000
<br />A . CLAIMS -MADE j X OCCUR ''....�
<br />';. DAMAGE TO RENTED $
<br />PREMISES (Ea. occurrence)
<br />500, 000_.
<br />2K057465702
<br />..
<br />1.0/1/201.6 10/1/2017 MEDEXP(Anyoneperson) $
<br />--. -_ it
<br />15,000....
<br />.....
<br />PERSONAL SADV INJURY $
<br />1,000,000•......
<br />I GENT AGGREGATE LIMIT APPLIES PER
<br />'..,. 'GENERAL AGGREGATE.... I..$
<br />2,000,000
<br />X 'POLICY JECTPRO- LOC
<br />PRODUCTS-COMPlOPAGG $
<br />2,000,000
<br />.........
<br />I
<br />...
<br />OTHER
<br />$
<br />AUTOMOBILE, LIABILITY
<br />COMBINED SYNCLE LIMIT $
<br />(Ea acadenl)
<br />1,000,000
<br />.........
<br />8 X..... ANY AUTO
<br />BODILY INJURY (Per person) $
<br />AHTCS NFAUTOSSCHFOtII..fI} AW3A377777
<br />_.
<br />8/26/2016 8/26/201I BODILY INJURY (Pei accident) $
<br />NON -OWNED
<br />'... HIRED AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />L. , (Per accident) -
<br />ccident)_Uninsuredm©toristoornbined
<br />Uninsured matonst oorroined$
<br />300,000
<br />X UMBRELLA LIAR X! OCCUR
<br />EACH OCCURRENCE -:. $ .....
<br />2,000,000
<br />EXCESSLIAB I.. I CLAIMS -MADE.... ''.,
<br />_..
<br />AGGREGATE... $
<br />........
<br />22,00..0,000..
<br />DED ',. RETENTION ESA57465702
<br />'....,.$
<br />10/1/2016 16/1/2017
<br />WORKERS COMPENSATION
<br />X STAR,TUTP OTRH-
<br />AND EMPLOYERS' LIABILITY YIN '...
<br />.........
<br />....
<br />ANY PROPRIETORIPARTNERlEXECUPVE
<br />OFFICERIMEM.BER EXCLUDED? ,N/Al
<br />SII
<br />: E.L. EACH ACCIDENT : $ ..........
<br />1., 000, qqq.....
<br />.......- ...
<br />TD (Mandatory In NH) 1620476--2016
<br />2/26/2016 2/26/2017 E.L. DISEASE - EA EMPLOYER $
<br />1,000,000
<br />If yes, describe Linder......_
<br />DESCRIPTION OF OPERATIONS below i i
<br />'; '. E . DISEASE:. - POLICY LIMIT '...., $
<br />1,000,000
<br />I
<br />e
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,. may
<br />be atkached If ran required)
<br />The City of Santa Ana, it's officers, employees, agents,
<br />and repres ntative are inc as additional
<br />.insured per the attached endorsement.
<br />qq 99
<br />MW.wal�k ±� 91 R9✓�,,�A
<br />%,r_m I. Irit,A i n MULUCK L:ANULL.LA I IIUN
<br />1(714)647-6944 SCUE"VAS@SANTA-ANA.ORG
<br />City of Santa Ana
<br />Attn: Purchasing Department
<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 BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Alessandra/PETERS
<br />Q9 1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 on14n11
<br />
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