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<br />ERIFICA T E OF LIABILITY U
<br />INSRANCE 410612016
<br />C T
<br />THIS CERTIFICATE IS ISSUED AS A MA'FTER OF INFORNIAIION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER. 71-11S
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED V THE PoLicRES
<br />SELOW. THIS CERTBF;CATE OF: INS1JRANCE DOES NOT CONSTITUTE A CONTRACT BEIWEEN THF-a ISSUIN(3 INSURER�SJ, AuTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CER7IFICA'TC--. HOUDER.
<br />M RORIANT; If the -erffcjte haIder is an ADDiIDONAL INSURED, the. po cy(ws) must be endcgsad. If SUBROGATION 6 WABVED, subject to
<br />the terms and conditions of the policy, cerfiam 1p¢ -Aicies may require an ordorsfrrncnt- A statement on lh s certificate does not confor rights to the
<br />cedificate, F"Ader in heu of such endorsNTIent(si.
<br />PRODUCER Hub Hiternatsonal Insurance
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<br />Sawyer Cook Insurance "F" 'A' X
<br />1200 Cahfornia St., Ste 260 Eoy jpg ,435-0237
<br />Redlands, CA 92374 r 5, l,rmlcg�riii�s_e�,�lwyev�,-,00k.com
<br />Sawyer Cook Insurance
<br />hSUIIRFIR A S,wlfilnel Insurancle 210
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<br />fNSURE D WestbOLmd C.rimrnun�cabons, hic 04SURER 5 Hartford Insurance Comp�Njy 122357
<br />Scott Sraith INSURER c Axis Speciatty Insurance Co.
<br />625 The CIty Cr., Ste 4,30
<br />Orange, CA 92888 11, -�I,�IRIR D
<br />urdi >torad:rt t:
<br />COVERAGES
<br />DER NFICATE NUMBER
<br />REVISdON NUMBER
<br />HIS IS TO CEWkFY I•AT IN&r FOR rHE, PICLICY
<br />,1[7 (37jR3.1RTkKTF: l"I-D BELOVJ HAVE BEEN 13S�KZ TO rIU7 RED NAMED ABOVII
<br />PERIOD
<br />INDCA"IED NOTWII'4G ANY REQUIREMENT, TERM OR CON0170,14 OF ANY CON17RAC'l OR, OIHER DOCUNIEN" onr H RESPECT TO WMCH
<br />1WS
<br />CLRF,FK,A1F MAY IIE ISSUED OR MAY PERTAIN, THE INSURANCE AFORDED BY
<br />rHE POLvEs Dl SCRIBEr) HERDN IE SeqWECT TO ALL IHE
<br />TFEmAS,
<br />EXCI: U&ONS AND CONDr+CNSOF SUCH POLICiES LIMIrs SHO VN MAY HAVE G,�.E.N
<br />REDiCED BY PAID CfAIW".
<br />NSk T
<br />LTR TYPE OF INSURANCE
<br />TIA r5t U 94� . ....... 7
<br />PCILXY EIP7 Roucy F.XP,
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<br />C AIMS WADE
<br />x x 72SBAAE3737
<br />05106=16 1 05106120 f 7 OWNfT Yo A`N,,,�n
<br />300,00
<br />A X Bus Interuption
<br />72SBAAE3737
<br />0510612016 0510612017 W I I F KP Nk�y In e ro�,,Ur�
<br />10,00
<br />A Prop Spoc forrn
<br />!72SBAAE3717
<br />05i Q6=16 05/06/2017: FERS1',NAL P� AOIVINI,�ZJRY
<br />2,000,00
<br />GEN�
<br />��-NERAL AGGREGATE
<br />4,000,00
<br />X PRn
<br />POUCY &C r LOC
<br />4,000,00
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<br />AUTOMONLE hJABILFTf
<br />A 72SBAAE3737 JM06120161 MM2017 FlOnK"Y'�rx,�lR�ff'a*rar:c[DarYr NJU'� AIA D �icoy �i S
<br />PROPER Y D,WI,GE
<br />I AUTOS
<br />1 X 1140- 0 A005 NJ OWNE 0,
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<br />1111AARrL L.A a IAR n
<br />OCCUR ��AiorCu "E 3 2,000,00
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<br />:7 2,3 B A A E 3 7 3 7 05106/2016' 0510612017 AGGREGA,i, S
<br />I ID ID V HE �TNIK)N
<br />. .... . PNT --75�=-
<br />VMRKERS COMPENSATION x TF I Li�
<br />AND EM Pt OYERSAJABIHTY
<br />4AY PRO
<br />PR9ErOFUEARTNEW° 1 T 72WECl.R3783 09128/2016 09)28,'2016 E L EACH ACCIDEN r I$
<br />OIF� EXCLJUH E MSEASE EA WPLOV��V; 1,0100,00
<br />—J� N A
<br />�O(r y Rr C RdePsT c r,)bN u0,� q
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<br />PCRA rXl . 9.....1... 2 ....5..
<br />01 ,12,216 C.1 eWEAaStE e POL ICY S 1,000,00 Mand,Vary m Nrnde
<br />rofessional Liab CNG00234,351501 005 095 Aggg
<br />DED
<br />... ........... .
<br />DESCRIPr�ON OF OPERAT8ONS (LOCATICINa (VFH CLESI (AC ORD Wl, Addid.—a Remark4 ho M ach.d If mom .5—,
<br />The City of Santa Ana, offIcers, ern �oyevs, agents, volunteers and
<br />representatives are ilarned AddftionaIi P112red per form 61-112001186 which
<br />includes 30 day notice of cancellation, Prir nary wording and Waiver of
<br />Subrogation apply perform SS00080405 attached to the policy
<br />City of Santa Aria
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />AGORD 25 j2014101)
<br />SHOULO AN( OF THE ABOVE DESCROED POLICIES BE CANCELLED BEFORE
<br />rHb. EXPIRAf rON DALE THEREOF, NOTHE rTW BE DELIVERED IN
<br />ACCORDANCE WH14THE POLICY PRWSIONS.
<br />AUTHORIZED RF..-B` E:SF,1JTATJVF
<br />Sawyer Cook insurance
<br />1988,20,14 ACORD CORPORATION. Ad riclfits reserved.
<br />The ACN D inarie and I0qD are registered rnar ks of ACORD
<br />
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