|
ACC> H CERTIFICATE OF LIABILITY INSURANCE
<br />F DATE tMM,AAIYYYY)
<br />09/26/2017
<br />THIS CERTIFICATE IS ISSUED ASA 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(les) must have ADDITIONAL INSURED provisions or be endorsed..
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />NOO.ME Kimberoy Kelley
<br />Insurance Solutions
<br />AHoNN _ (949)348,7400 AIC Net: (949)348-2373
<br />License #0746539ApDRESS:
<br />KimKQIns-SOlulions.COm
<br />33302 Valle Rd, Suite 200
<br />MSURERVd AFFORDING COVERAGE
<br />NAIC 1t
<br />San Juan Capistrano CA 82675
<br />wsuaERA: The Ohio Casualty Insurance Company
<br />24074
<br />INSURED A„_, Qa )„ a) - :v�d l"
<br />INSURER B: Allmerica Financial Benefit
<br />41840
<br />Professional Sports Field Maintenance lnc )
<br />INSURERa American Flre and Casualty Company
<br />24066
<br />23 Emerald GlnState
<br />Com Ins Fund
<br />INSURER e: P
<br />35076
<br />INSURERE:
<br />...MED
<br />Laguna Niguel CA 92677
<br />INSURER F:
<br />A
<br />COVERAGES CERTIFICATE NUMBER: 11-10AII REVISION NUMBER -
<br />THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
<br />CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LTR
<br />TYPE OF INSURANCE
<br />INSD
<br />MD
<br />POLICY NUMBER
<br />MMILD�IVYYY
<br />CYEX
<br />MMIODA'YYIrI
<br />LIMITS
<br />x COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE L' I OCCUR
<br />EACH OCCURRENCE
<br />$ 1,000,006
<br />PREMISES Ea occurcence
<br />S 500,000
<br />EXP (Any ane parson)
<br />$ 15,000
<br />...MED
<br />PERSONAL&ADV INJURY
<br />s 1,000,000
<br />A
<br />BKO57465702
<br />10/01/2017
<br />10/01/2018
<br />GEN'L AGGREGATE LIMITAPPUES PER:
<br />x POLICY❑PRO- ❑
<br />JECT LOC
<br />GENERALAGGREGATE
<br />S 2,000,000
<br />PROAUCTaCOMPtOPAGG
<br />S 2,000,000
<br />$
<br />OTHER:
<br />AUTOMOBILE
<br />LIABILITY
<br />Ea MBBI tlEDI SINGLE LIMIT
<br />s 1,000,000
<br />BODILY INJURY (Far person)
<br />$
<br />X
<br />ANYAUTO
<br />OMEB AUTOS AUTOS
<br />AUTOS ONLY AUTOS
<br />AW3A377777
<br />08126/2017
<br />08/26/2018
<br />BODILY INJURY(Peraseld.n)
<br />5
<br />HIRED NON-OWNEO
<br />AUTOS ONLY AU70SONLY
<br />PROPERTY MAGE
<br />dre, acdda.0
<br />s
<br />Uninsured motorist
<br />s 300,000
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />C
<br />EXCESS UAB
<br />CLAIMS MADE
<br />ESA57465702
<br />10/01/2017
<br />10/01/2018:.
<br />AGGREGATE
<br />S 2,000,000
<br />DED RETENTION S
<br />s
<br />D
<br />COMPENSATION
<br />AND EMPLOYERS 'LIABILITY YIN
<br />ANYCERIMEETORtPARTUDED?ECUTIVE ❑
<br />(MPandatoryan NH) EXCLUDED?
<br />Vd0506be antler
<br />DESCESCRIPTION OF OPERATIONS below
<br />NIA
<br />1620476-2017
<br />02/26/2017
<br />02/26/2018
<br />PER
<br />X OWORKERe
<br />_
<br />E.L. EACrI ACCIAENT
<br />s 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />S 1.,000,009
<br />E.L. DIBEASE-POLICY LIMIT
<br />$ 1,OOD,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (ACORD101,Additipna1Remarks Schedule,maybeattadbedlfmore space lsrequu`
<br />The City of Santa Ana, it's officers, employees, agents, and representative are Included as additional Insured per t�,gNlb°tlad en orseme.t.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988-2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2010103) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />20 Civic Center Plaza
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />f.�d�.�...,.�..i
<br />©1988-2015 ACORD CORPORATION, All rights reserved.
<br />ACORD 25 (2010103) The ACORD name and logo are registered marks of ACORD
<br />
|