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AC"RV � DATE (MMIDOJYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 9/26/2016
<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 INSUIRER(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 />conlrACi
<br />PRODUCER .„...� Robin Holloway
<br />Insurance Solutions
<br />License #0746539
<br />93302 Valle Rd, Suite 200
<br />San Juan Capistrano CA C92675
<br />INSURER- -_ ,-„t�"""� 4�...,»,�,✓""wr f..~
<br />Professional Sports Field Maintenance Inc
<br />23 Emerald Gln
<br />(t):(949)348-7400
<br />RobinH@ins--solutions.com
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURERA:The Ohio Casualty Insurance
<br />INSURER El Allmerica Financial Benefit
<br />INSURER.0 American Fire and Casualty
<br />INSURER.D:State Comp..... Ins Fund........
<br />(949)348-2373
<br />NAIC #
<br />_Company 24074
<br />41,840
<br />Company 24066
<br />35076
<br />I'.NSURER E:
<br />Laguna Niguel CA 92 677 INSURER F
<br />COVERAGES CERTIFICATE NUMBER:1.6-17 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. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 />(NSRTYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP
<br />LTR POLICY NUMBER MMlOD1YYYY MMlDDlYYYY.
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY1,000,000
<br />EACH OCCURRENCE
<br />$
<br />A ,. CLAIMS -MADE X OCCUR
<br />_.,
<br />DAMAGES ( RENTED
<br />PREMISES (Ea occurrence)
<br />$+
<br />500,000
<br />_-.
<br />SK057465702
<br />10/1/2016 10/1/20.17
<br />MED EXP (Any one Person)
<br />$
<br />15,000
<br />'....
<br />PERSONAL & ADV INJURY
<br />$
<br />1,000,000
<br />GEN'LAGGREGATE LIMIITAPPLIES PER ..
<br />'....
<br />GENERAL AGGREGATE
<br />$2,'000,000
<br />PRO -
<br />PRO -
<br />POLICY POLICY LOC
<br />.... ....... _..
<br />P A
<br />PRODUCTS - COMPIO.._..GG
<br />$......
<br />2,000,000
<br />OTHER;
<br />$
<br />AUTOMOBILE LIABILITY '....
<br />...,
<br />COMBINED SINGLE LIMI"7
<br />(Ea accident),..
<br />$
<br />1 000 000.
<br />'
<br />ANY AUTO
<br />BODILY INJURY (Per Person)
<br />$
<br />-.........
<br />...
<br />ALL C?WNED SCHEDULED AW3A377777
<br />AUTOS _ AUTOS
<br />B/26/2016 8/26/2017
<br />BODILY INJURY (Per accident)
<br />$
<br />NON -OWNED ..
<br />PROPERTY DAMAGE
<br />HIRED AUTOS AUTOS
<br />...
<br />(Per aczdent)_„
<br />Uninsured motorist combined
<br />$
<br />300,000
<br />X UMBRELLA LIAR X OCCUR '.
<br />EACH OCCURRENCE'.
<br />_.....
<br />$ ...
<br />2,000,000
<br />C EXCESS LIAR CLAIMS -MADE
<br />_.
<br />''.
<br />AGGREGATE.
<br />_. .. ......
<br />$
<br />2, 000, 000 '...
<br />DED RETENTION$ ESA57465702
<br />10/1/2016 '.... 10/1/2017
<br />$
<br />WORKERS COMPENSATION
<br />X PER OTH-
<br />AND EMPLOYERS' LIABILITY Y 1 N
<br />STATUTE ER
<br />ANY PROPRIETORIPARTNERlEXECUTIVE
<br />E1 EACH ACCIDENT
<br />$
<br />1,000f 000....
<br />OFFICERVM MBER EXCLUDED? iN1A
<br />D (Mandatory in NH) 1620476-2016
<br />2/26/2016 2/26/2017
<br />.......
<br />1 DISEASEEA EMPLOYEE $
<br />1, 000 000
<br />r
<br />If yes, describe under'
<br />..._......_
<br />._...
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />1,000,000
<br />(DESCRIPTION OF OPERATIONS I LOCATIONS C VEHICLES (ACORD 101, Additional Remarks Schedule, a tteched Ittrmore space is requilre
<br />The City of Santa Ana, it's officers, employees,
<br />agents, and represents
<br />001-
<br />are included as
<br />additional
<br />insured per the attached endorsement.
<br />fi ;;c.?_
<br />b
<br />A0
<br />'
<br />t �
<br />RC
<br />P
<br />l,..t,K I It-It,A I t NULLPCK l AIVLtLLA I IUN
<br />(714) 647-6944 SCUEVAS@S'ANTA-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 THIE 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/;r'1 TERS ' . ,.."%
<br />O 1988-2014 ACORD CORPORATION. All rights reserved..
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks Of ACORD
<br />INA025 oo i4ltr i.
<br />
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