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r, 0 DATE (MM100iYYYY)
<br />AC"R" CERTIFICATE OF LIABILITY INSURANCE
<br />(►�' 2/21/2017
<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 />INSR -_- .......- ..----AODL SUER_... ......- _..
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />Insurance Solutions
<br />PHONE (949)548-7400 FAX
<br />(AIC, No, Ext): (A1C, No): (349) 348-2373
<br />License #0746539
<br />E-MAIL
<br />ADDRESS: RobinH@ins—solutions.com
<br />33302 Valle Rd., 'Shite 200
<br />INSURER(S) AFFORDING COVERAGE NAIC4
<br />San Juan Capistrano CA 92',675
<br />.....
<br />INSURERA:The Ohio Casualty Insurance Company 24074
<br />INSURED
<br />INSURER B :A11121ariCa.. Financial Benefit --. 41840
<br />Professional Sports Field Maintenance Inc
<br />INSURER C: American Fire and Casualty Company 24066
<br />23 Emerald Gln
<br />INSURERD:State Comp Ins Fund 35076
<br />I
<br />I I n � 1: I✓ �q,
<br />_
<br />u
<br />/
<br />INSURER E: _
<br />Laguna Niguel CA 92677
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:1.7-18 WC renewal. RFVIRlrtN NI II11IRFIQ"
<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
<br />THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSION'S AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR -_- .......- ..----AODL SUER_... ......- _..
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />.._POLICY EFF POLICY EXP ..... ..._.. -_--
<br />(MLIMITSMMIDOIYYYY LIMITS
<br />_.._.
<br />X COMMERCIAL GENERAL (LIABILITY
<br />EACH OCCURRENCE $
<br />1,000,000
<br />A CLAIMS -MADE X OCCUR
<br />-- --- -
<br />(DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $........
<br />500 , 000
<br />... _..
<br />......... ..._. _-. BK057465702
<br />7,0/1/2016 10/7./201.7 MED EXP (Any one person) $
<br />15,000
<br />. ..._.
<br />PERSONAL & ADV INJURY $
<br />1,000,000
<br />(3FN'L. AGGREGATE LIMIT APPLIES PERS
<br />GENERAL. AGGREGATE $
<br />21,000,000
<br />X POLICY _ PRO-
<br />JECT LOC
<br />PRODUCTS -COMPfOPAGO $
<br />2,000,000
<br />OTHER:
<br />$
<br />AUTOMOBILE LIABILITY
<br />COMBINED SINGLE. LIMIT $
<br />1,000,000
<br />........
<br />(Eaaccidenl)__ .........
<br />,
<br />B X..... ANY AUTO _...
<br />BODILY INJURY (Per personl $
<br />ATOS AUTOS SCHEDULED
<br />...... AUTOS AUTOS AW3A3.7..777.7
<br />8/26/2016 9126/707.7 BODILY INJURY (Per acadent).$........
<br />HIRED AUTOSNON-OWNED
<br />_ AUTOS
<br />PROPERTYDAMAGE._... $
<br />.(Per awdenl)... ........
<br />.
<br />Uninsured motorist combined $
<br />300,000
<br />X UMBRELLA LIAR X OCCUR
<br />EACH OCCURRENCE $
<br />2,000,000
<br />CL.AI..MS-MADE.
<br />C EXCESS LIAR _... -_. ..
<br />AGGREGATE $
<br />2,000,000
<br />DED RETENTIION$ ESA57465702
<br />10/1/2016 1.0/7./2017 $,
<br />WORKERS COMPENSATION....
<br />x PER
<br />AND EMPLOYERS' LIABILITY Y i N
<br />STATUTE ER
<br />ANY PROPRIETORIPARTNERIEXECUTIVE ....
<br />OFFICER/MEMBER EXCLUDED? N1 1A
<br />FL EACH ACCIDENT $
<br />.... _.
<br />1, 000, 000.
<br />--0
<br />D (Mandatary in NH) 1620476--2.01.7
<br />2/26/2017 2/26/2018 EL 06EASE - EA EMPLOYEE $
<br />1,000,000
<br />If yes„ describe under.
<br />.... _...---.
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY' LIMIT $
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS d LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached i6 more space i r d)
<br />The City of Santa Ana, it's officers, employees, agents,
<br />and represent,�ue are included as additional
<br />insured per the attached endorsement.
<br />\"
<br />\\
<br />s..crcumr-KIIAIcnVLI I UANI;tICLAtIU'N '^
<br />(714)647-6944 SCUEVAS@SANTA-ANA.ORG
<br />City of Santa; Ana
<br />Attn: Purchasing Department
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014/01)
<br />INS025lanuni i
<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-4'w7
<br />Q 1988-2014 ACORD CORPORATION(. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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