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ACCPR1:> CERTIFICATE OF LIABILITY INSURANCE
<br />ATE
<br />FD ra9r2o16Y)
<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($), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in frau of such endorsement(s).
<br />PRODUCER
<br />NAMECT Robin Holloway
<br />_.. _.
<br />Insurance Solutions
<br />License 60746539
<br />41 348-2087
<br />..._" FAX,
<br />(949)348-2086 _.._ m._e_.— 1C NAc 049048-2087
<br />c 14. 11 .mmm
<br />MAIL ADDRESS: robinh@ ins -solutions.com,
<br />33302 Valle Rd, Suite 200
<br />INSURER(S) AFFORDING COVERAGE a NAICA
<br />San Juan, Capistrano CA 92675
<br />INSURERA:The Ohio Casualty insurance Company., 24074.
<br />INSURED
<br />INSURERBA11.meriCa Financial Benefit.
<br />41840'..
<br />-INSURER CAmerican Fire and ^Casuaity Com an
<br />�u.._..__.._
<br />24066
<br />Professional Sports Field 'Maintenance Inc
<br />WSURIERD:State Comp Ins Fund
<br />35076. _
<br />23 Emerald Gln
<br />........ _
<br />INSURER E ;
<br />$ _'_15_'_00O
<br />INSURER F
<br />Laguna Niguel C.A. 92677
<br />COVERAGES CERTIFICATE NUMBER.16-17 WC Renewal 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 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />-_
<br />IN'..:SR
<br />L
<br />TYPE OF INSURANCE
<br />U POLICY NUMBER . _,._.POLICY
<br />M al 71YEYYY
<br />POLICY EXP
<br />LIMITS
<br />X COMMERCIAL GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />1 , 000 000
<br />$ r
<br />A
<br />CLAIMS -MADE X OCCUR
<br />I
<br />DAMAGE E TO RENTED
<br />PREMISES [Ea oca+rI,
<br />S 500,000
<br />MED EXP (Any one person) „ .l
<br />$ _'_15_'_00O
<br />BK056274048
<br />12/21/2015
<br />12/21/2016
<br />mGE:N'L
<br />PERSONAL BADV INJURY
<br />$1 OOO,ODO
<br />GENERAL AGGREGATE
<br />1$2,000,000
<br />AGGREGATE LIMIT APPLIES PER i�
<br />J
<br />PRO- LOC
<br />JEOT
<br />PRODUCTS - COMP/OP AGO
<br />a,g00,O2,000,000POLICY
<br />$ _.........
<br />OTHEW
<br />$
<br />AUTOMOBILE LIABILITY ISI
<br />BINE L Li
<br />Ea acc+denkJ,
<br />It 1,000,000
<br />H
<br />X ANY AUTO
<br />BODILY INJURY (Per person)..
<br />$
<br />ALL OWNED 1 SCHEDULED
<br />_ AUTOS 4 AUTOS
<br />j[ Aw3A377777
<br />8/26/2015
<br />B/26/201.6
<br />BODILY INJURY(Per accident)
<br />$
<br />NON'-OWNEDPR4PERTYDAMaGE
<br />__$HIRED
<br />AUTOS AUTOS
<br />ri
<br />Per accldenf
<br />__..,..-
<br />I
<br />Unirsuredm,ctovistcombined
<br />$ 300,000
<br />X.. UMBRELLA LIAB X OCCUR
<br />1
<br />I
<br />EACH OCCURRENCE ...".
<br />$ 2,000,000
<br />EXCESS LIAR E CLAIMS-MADEi
<br />S
<br />r
<br />, At9GREGATE $ 2,0 170�QO
<br />DED f u RETENTION i
<br />E5A56274048
<br />10/1./2015
<br />10/1./2016
<br />a $
<br />WORKERS COMPENSATION r
<br />f
<br />i x PER OTH
<br />AND EMPLOYERS" LIASIU Y Y 1 N
<br />f
<br />ST,n,, UT___E �.._ Ej
<br />ANY PROPRIETOR)PARTN'ERlEXECUTIVLE,.L.
<br />�, N 1 A
<br />'.
<br />EACH ACODENT $ 100 000
<br />0
<br />D
<br />OFFICERIMEMBER EXCLUDED'?..
<br />(Mandatory In NH)
<br />1620476-2016
<br />2/26/2016 2/26/2'.017
<br />.--- - ---
<br />E.L. DISEASE - EA EMPLOYE $,� 000 X000
<br />K es, desobe under
<br />E.L, DISEASE - POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS oelow i
<br />DESCRIPTION OF OPERATIONS I LOCATIONS 7 VEHICLES (ACORD 1101, Additlonal Remarks Schedule, may be attached If more space Is required)
<br />The City of Santa Ana, its officers, employees, agent's and representatives are included as additional
<br />insured per the attached endorsement. 6 >tif°,
<br />p A + i7
<br />�e"'qle�
<br />as
<br />City of 'Santa Acta.
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />ACORD 25 (2014/01)
<br />1 N 8025 0() 1401 i
<br />SHOULD ANY OF THE AEP415bESCAMED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATt THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />T Alessandra/?ETERS -Z' � �• "••
<br />@ 1988-2014 ACORD CORPORATION.. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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