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AC40R o CERTIFICATE OF LIABILITY INSURANCE DATE 618/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the PRODUCER Paczolt Insurance Alliance One Westbrook Corp Center Suite 330 Westchester IL 60154 INSURED Peter M. Small, Historical Impressionist PIAI LLC al (708) 579-3126 _'AIC Nal: (988)333-1239 holly@paczolt.com INSURER(S) AFFORDING COVERAGE _ _ NAIC p 3URERAMesa Underwriters Specialty ins Co 136838 Peter M. Small INSURERD: PO Box 3452 INSURER E: Fullerton CA 92839 INSURER F: COVERAGES OFRTIFIr:ATF NIIMRFR.15-16 Peter M Small RFVIS Ir1N NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR LTR TYPE OFINSURANCE IADOLiSUBR'. POLICY NUMBER T POLICY EFF MMIDCIVYYY POLICY EXP DI N IDVYVV LIMITS X COMMERCIAL GENERAL LIABILITY I- A I 17 CLAIMS -MADE X OCCUR X i,. MEP0012009000283 10/6/2015 10 /6/2016I EACH OCCURRENCE II$ 1,000,000 DAMAGE TRENTED PREMISES Be occurrence $_ 100,000 _ MED EXP(Any one person) 5,000 _;_$ PERSONAL INJURY $ 1,000,000 GEN'L AGGREGrATE LIMIT APPLIES PER X'. POLICY AGGREGATE jET_ 71 LOC II ' i --- _ ,GENERAL AGGREGATE $ 2,000, 000 PRODUCTS - COMP/OP AGO $ 1,000,000 $ .. ., OTHER',,. ' AUTOMOBILE LIABILITY ANY AUTO ALL OWNED I,N SCHEDULED AUTOS F__. AUTOS _ HIRED AUTOS Ir I NON -OWNED AUTOS - COMBINED SINGLE LIMIT $ Eaecclden9__ _ - BODILY INJURY (Per person) II$ _ BODILY INJURY (Per accident) $ \n'R,I• ! PROPERTY DAMAGE - $ vYE 4< ereccdfmp $ UMBRELLA LIAB OCCUR N I EACH OCCURRENCE _ $ EXCESS LIA�ET ',. AGGREGATE $ DEpENTION$ GJ y WORKERS NSATION Y AND EMPLO ERSELIA ILIITV 'NIA ANY PROPRIETOR/ OFFICERIMEMBER EXCLUDIUEXECUTIVE (Mandan In NH �.� if yes, describe under DESCRIPTION OF OPERATIONS below '�° I PER STATUT BLEACH ACCIDENT ERH ... � EL DISEASE-POLICYLMIE $ $ _--- DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The Certificate Holder is listed as an additional insured with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. This insurance shall be primary and non-contributory to insurance or self-insurance carried by the City of Santa Ana The City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 P 11912"as!L1111i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Scheive/HOLLY ©1988-2014 ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 iPnlnnl i