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A-2015-119 <br />-- <br />' 0 <br />AIC'"R" CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDlYYYY) <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS„ <br />11/2812016 <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 CONTRACTBETWEEN 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 <br />Hiscox Inc. d1b1a1 Hiscox Insurance A enc In CA <br />� y <br />.,_NAME: .- .. _......... ....-.-_-.....�_ <br />PHONE 888 202 3007 FAX <br />_LAIC Nu. Ext), . (8 88) (AIC (+lot: <br />.._. <br />520 Madison Avenue <br />E-MAIL <br />ADDRESS: COntaCt@',hIscox.COm <br />32nd Floor <br />INSURER(S),,AFFORDING,CO'VERA.GE_ _,.._,........ NAICII:,... .... <br />New York, NY 10022 <br />INSURER A: Hliscox Insurance Company Inc 10200 <br />INSURED <br />INSURER B: <br />STRAIGHTLINE COMMUNICATIONS <br />INSURER c <br />14930 Greenleaf Street <br />INSURER D <br />'.. INSURER E : <br />INSURER F: <br />—PREMISES „tEa occurrence}____..._, <br />Sherman Oaks CA 91403 <br />rnvccrAt^_cc r FI7YIRIt^ tl7F NdIIIIARI=P- REVISION NUMLSt,K: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURER' 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 />POLIC <br />TIN 17R .� TYPE OF INBURANCE .............. AIDDL SUBR'� ............POLICY NUMBER �......- MMIDDIY"YYY....I MMI.DIYYYN (LIMITS <br />LTR <br />&9" <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />S <br />DAMA_ TO RENTED <br />CLAIMS -MADE OCCUR <br />—PREMISES „tEa occurrence}____..._, <br />S <br />MED EXP (Any one person) <br />$ <br />PERSONAL 8 ADV INJURY <br />S <br />GENL <br />AGGREGATE LIMIT APPLIES PER: <br />GENERALAGGREGATE <br />S <br />R O LOC <br />POLICY D PRO- <br />JECT <br />PRODUCTS - COMPICJP ACG_ <br />'......._. <br />.. <br />S <br />.............. <br />OTHER: <br />COMBINED SINGLE LIMIT <br />$ <br />AUTOMOBILE LIABILITY <br />Ea'accldgn3i ........ <br />. .......__. <br />BODILY INJURY (Per Person) <br />S <br />_. <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Per acddenl;l <br />$ <br />.. AUTOS AUTOS <br />NON-OWNEID <br />PROPERTY (DAMAGE <br />HIRED AUTOS AUTOS <br />LPer accident), <br />i <br />$ <br />UMBRELL.ALIAB <br />OCCUR <br />H <br />I... <br />EACH,OCCURRENCE <br />$ <br />EXCESS LIAR <br />-MADE <br />AGGREGATE <br />S <br />..CLAIMS <br />DED RETENTIONS <br />_ <br />$ <br />WORKERS COM,.PENSATION, <br />PEAR 0TH - <br />S'EATUTE 1 ER <br />li <br />k <br />AND EMPLOYERS" LIABILITY YIN <br />._..._.._... <br />�"'ry <br />E. -U_. EACH ACCIDENT <br />$ <br />.- ...-... <br />E.L. (DISEASE- EA EMPLOYEE <br />.....--.- .............. <br />.,., ....._.._. <br />$ .... ...-__— <br />OFFICER/MEMBER EXCLUDED? u <br />OF <br />(Mandatory in NH) <br />N 1A <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. (DISEASE - POLICY LIMIT <br />S <br />Professional Liability <br />Each Claim: $ 1,000,000 <br />A <br />Y <br />UDC -1531232 -EO -17 <br />01%12/2017 <br />0111212018 <br />Aggregate: $ 1,000,000I <br />DESCRIPTION OF OPERATION'S I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) <br />The City of Santa Ana and its officers, employees, agents, volunteers and representatives each while acting under the direction of The City of Santa Ana are <br />named as additional insureds. <br />ncoTtcarA'rc vr'it rnco t'AWr'.RI I ATWIN <br />The City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <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 />&9" <br />ACO'RD 25 (2014101) <br />fJ 11JUB-ZU14 A( LIKL1 I,;UKF'UKA I FUN. Ali rignLS re5erveu, <br />The ACORD name and logo are registered marks of ACORD <br />k <br />f l',• an <br />