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A-2015-119 <br />DATE <br />CERTIFICATE OF LIABILITY INSURANCE <br />L 11(MWDDNYYY) <br />Gs /28/2016 <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 <br />NAME <br />Hiscox Inc. dib/a/ Hiscox Insurance Agency in CA <br />PHONE <br />J.1A <br />(888) Hq?-3007 X <br />520 Madison Avenue <br />E MAIL <br />URESS: contact@hiscox.,co <br />32nd Floor <br />INS_ UREEJ§1AFF0RP!qG_COVERAGf A - <br />New York, NY 10022 <br />INSURERA: Hiscox Insurance Company Inc 10200 <br />INSURED <br />INSURER S L <br />STRAIGHTLINE COMMUNICATIONS <br />I <br />14930 Greenleaf Street <br />_INSURER D: <br />_LN—'YFERE : ...... . . .. <br />Sherman Oaks CA 91403 <br />INSURER F: <br />COVFRAGFS CERTIFICATE NUMBER., 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 />iRsk .... _'­�,WDDL7 SUER <br />LTR TYPE OF INSURANCE I. WVD POLICY NUMBER IMMIDDNYYYMMQDfYYYYI LIMITS <br />N� <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ 1,000,000 <br />CLAIMS -MADE OCCUR <br />DAMAGE TO RON'TEd <br />$ 100,000 <br />MED EXP (Any one person) <br />$ 5,000 <br />PERSONAL & ADV INJURY <br />A <br />.. . ........ <br />y <br />UDC -1531232 -CGL -17 <br />01/12/2017 <br />01112/2018 <br />GEI <br />AGGREGATE LIMIT APPLIES PER: <br />_GFNERALA925EGATE <br />s 2,000000 <br />X� <br />RO- <br />POLICY E PECTLOC. <br />S/T Gen. Agg. <br />_PRqRUCTS-COMP�OPA.GG <br />OTHER <br />LIABILITY <br />COMBINED LIMIT <br />_(�p acolden,L <br />ANY AUTO <br />BODILY INJURY (Per person) <br />$ <br />BODILY INJURY (Per accident) <br />-P -, PROPERTY DAMAGE <br />Per accident) <br />S <br />$ <br />ALL OWNED SCHEDULED.... <br />AUTOS AUTOS <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE <br />$ <br />DED � FRETENTION S <br />WORKERS COMPENSATION <br />AND EMPILOYERS'LIAWLITY YfN <br />ANYPRC)PRIETORIPARTNEFVEXECUTIVE F---1 <br />ERTUTE OTH- <br />TAR <br />_L 1 1—E1 <br />E.L. EACH ACCIDENT <br />SM IT <br />OF FICERIM EMBER EXCLUDED? <br />(Mandatory in NH) <br />NJA <br />F.L. DISEASE- EA EMPLOYEE <br />S <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />EJ . DISEASE -POLICY ICY LIMIT <br />$ <br />DESCRIPTION OF OPERATIONS 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 />Ut-K I II-JUA I It: HULL tAlN%,rLI_A I JUN <br />IThe Qty of Santa Ana <br />20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Santa Ana, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />3 <br />@ 19BU-2014 AGUKLI GUI I I IVN. AN rignts reservea. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />vu, <br />