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lC..vKL.J CERTIFICATE OF LIABILITY INSURANCE DATE(MM'F'D'YYYY) <br />05/25/2016 <br />THIS CERTIFICATE 13 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 INSUR,ER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certlflcate 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 rerjulre an endorsement. A statement on this certificate does net confer rights to the <br />certificate holder In Ileu of such endorsement(s). <br />PRODUCER CONTACT JIN KIM <br />INSURANCE LAND INSURANCE SERVICES PHONE. 213 -388- <br />4032 WILSHIRE BLVD 'MAT lnevraaC <br />ADORES <br />9TE 309 <br />NSURER S' <br />LOS ANGELES CA 90030 INSURER A: COLONY INI <br />INSURED INSURERS: EMPLOYER : <br />XANADU SERVICE SYSTEM, INC. INSURERC: INTEGON PI <br />3010 WILSHIRE BLVD. SUITE 315 <br />LOS ANGELES CA 90010. INSUneRF <br />COVERAGES CERTIFICATE NUMBER RFVISInN NI IMRRR- <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR C�NOITION 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 AY HAVE BEEN REDUCED BY PAID CLAIMS. <br />rjp <br />TYPE OF INSURANCE <br />ADD <br />V <br />pOLICYiNUMBER <br />MMIDDIYYYY <br />POLICDYYYP T <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACHOCCURRENCE <br />$ 1,000,000 <br />CLAIMS-MADE © <br />GL4171421 <br />09/15/2015 <br />09/15/2016' <br />° ° °-°-- --�°— <br />OCCUR <br />PREMISESOMgyyal__ <br />5 100,000 <br />MEDEXP(ARY One Perean) <br />$ 5.,000 <br />A <br />Y <br />Y <br />PERSONAL& AOV INJURY <br />$ 1,000,000 <br />GEN'L <br />AGGREGATE LIMIT APPLIES PER <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />:] PRO- <br />[ C7 <br />POLICY JECT OC <br />ECT <br />PRODUCTS - CONNOR AGO <br />$ 1,000,000 <br />OF R <br />$ <br />AUTOMOBILE <br />LIABILITY <br />2003172568 <br />06/04/2D1S <br />06/04/2016 <br />Eae cid oSlNL <br />,$ 1,000,000 <br />ANY AUTO <br />BODILY INJURY(Perp.mm,) <br />$ <br />Le <br />�AU <br />OS SCHEDULED <br />AUTOS AUTOS <br />'.. <br />BODILY INJURY (Par accidonl 1 <br />$ <br />HIREDAUTOS NON OWNED <br />AUTOS <br />PROPERTY DAMA E <br />_. <br />'$ <br />_ <br />If <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE <br />$ <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE <br />$ ... <br />CEO RETENTION <br />$ <br />WORKERS COMPENSATION <br />TH- <br />ANDEMPLOYERS'LIABILITY YIN <br />BIG 16634¢7 03 <br />04/02/301604/02 <br />/2017 <br />TA RITE R <br />E.L. EACH ACCIDENT <br />$ 1,000,000 <br />ANY PROPRIETORIPARTNER /EXECUTIVE <br />'.. <br />B <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />El, DISEASE - EA EMPLOYE <br />$ 1,000,000 <br />(Mandatory In NH) <br />If yca, describe under <br />DESCRIPTION OF OPERATIONS below <br />E1. DISEASE - POLICY I -I WT <br />$ 1 000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Renjarks Schedule, may bo adechad If more space Is required) <br />CERTIFICATE HOLDER IS AS AN ADDITIONAL INSURED. / $$ <br />CLERK OF THE COUNCIL <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA (M -30) <br />SANTA ANA <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 81: CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORRED REPRESENTATIVE <br />1 <br />CA 92701 � <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />