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HASSE-1 OP ID:
<br />DATE (MM(DU/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 1 0511512017
<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 have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsements}.
<br />____________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
<br />PRODUCER 703-385-7200 CONTACT CT Certificates
<br />NAM 1�7,,
<br />Business Benefits Group PHON , E703-385-7200 FAX 703-766-0202
<br />4023 Chain Bridge Rd (ArC, No' Exty LAIC, ii
<br />Fairfax, VA 22030 A-2016-246 E'MAIL certificateis4btigbrokeir 66M
<br />Brock Reynolds ADDRESS
<br />NSURERJSIAFFORDING COVERAGE NAIC
<br />114SUIIZER A Har4ord Casualty Insurance Co 29424
<br />lNSiJR1l:D Hassett Willis & AssociatesILI-C INSURERS Beazley Ins. Co
<br />TIA Hassett Willis & Company lNSURIER C:
<br />1100 New York Ave NW #250W
<br />Washington, DC 20005 114Si,)Rl:R D
<br />INSURER E:
<br />.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
<br />OVERAGES CERTIFICATE NUMBER: REVISION NUMBER
<br />CHAS IS 10 CERI @FY I HAI I HE F'OLICIES OF IIIISURAIIICE LISI ED BELOW HAVE BEEIII ISSUED TO I HE IIIISURED IIIAMED ABOVE FOR I HE POLICY F'EMOD
<br />CI` DICA1ED NOTWITHSIANDINI3, ANY REOil-ilREMENT lIERM OR (.,'OIqDITIOIq OF ANY (.,'OlqTRA(.,'1I OR OT1HF.:R DO(--li WITH RF.:S1::1F.:(.,-T IOW1ll(.,-1H THIS
<br />CF.:R11FICATF: MAY BF: SSI.JF:D OR MAY FIF:RIAIN, THF: lI',1SI.JRA;J',1CF.: AI FORDF.:D BY 11HE F1OLiCUS DF:SCRIBED HEREll',l IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONSAND CONDITIONSCid: SLICH POI[JOES. LIMITSSIHOWNIMAY IHAVE BEEN R(iDUCEDBY PAIDCLAWS.
<br />R UDDL .4USR POUCY IEFIF POLICY Ir
<br />TY RE OF 1114SURA114CE PoLcY NUMSIER JMM151Dffy-yy1 LU[i
<br />X COMMERCIAL GENERAL. LIABILITY IW �� I (Y X I ff �1: �11 I i� �F $ 1,000,0
<br />GIAXS MADE ['X OGGUR 42SBAlIG6094 04/11/2017 0411112018 UlAiMAGE l0i RIFWFID, 300,0
<br />I.................................
<br />GR41 AGGRIFGAflF U1110ii AI:111:14 iFS 11:1FIlk
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<br />EXCII:SS LAS Q, A[ iMS,NKIF
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<br />IM 11) 10000
<br />X RIL I ION �D
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<br />AND EMPLOYIERS'LABLTY
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<br />42WECC06606
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<br />OFF 1: XC11 101 T 04 /A
<br />(Windamiry In NH)
<br />4 A0H0C0JHRFN1F
<br />04/11/2017 04/11120119
<br />IS Prof E&O Liability
<br />V1566DI70401
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<br />e�lff'PT`a"r 0 RD 101 Additional Remarks Scpace is reqUired)
<br />IC eAOr6RAT'JqN' ' WICATIONS / VEHIJLES �fl aedule, may bu atitached !if i 111cilre
<br />,ers, agents, a em 16yees are name as
<br />6 er, is o I(.
<br />Additional Insured in regards to General Liability per attached SS0008 04/05
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />- .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
<br />CERTIFICATE HOLDERCANCELLATION
<br />............................................................................................................................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................................................................. .
<br />SANTANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ATTN: Purchasing Department
<br />20 Civic Cneter Plaza ALPHORIZED REPRESEi
<br />Santa Ana, CA 92701 SVI ',.qA� L16ql'
<br />................................ . ............... . . ........ . . . . . ..... . ................... . ................. . . .. . .................... . ...................................... .. .. .. . ..................................................................... ......................
<br />ACORD 25 (2016/03) Q 1988-2015 ACORD C 9,70RATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />ER -,I
<br />0411112017 0411112018
<br />80DRYiPLMR` 1P -s pemon�
<br />RODRY INJIeRa IPw,u `ndeiilH
<br />4 A0H0C0JHRFN1F
<br />04/11/2017 04/11120119
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<br />04/11/2017 0411112018
<br />a- .0 i::::,A� 1 U A"X iDLNT
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<br />E14SLASF , 11:1101i K"Y 11 KOH
<br />041231201710412312018
<br />-1-11:imlit
<br />i
<br />e�lff'PT`a"r 0 RD 101 Additional Remarks Scpace is reqUired)
<br />IC eAOr6RAT'JqN' ' WICATIONS / VEHIJLES �fl aedule, may bu atitached !if i 111cilre
<br />,ers, agents, a em 16yees are name as
<br />6 er, is o I(.
<br />Additional Insured in regards to General Liability per attached SS0008 04/05
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />- .....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
<br />CERTIFICATE HOLDERCANCELLATION
<br />............................................................................................................................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................................................................. .
<br />SANTANA
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS.
<br />ATTN: Purchasing Department
<br />20 Civic Cneter Plaza ALPHORIZED REPRESEi
<br />Santa Ana, CA 92701 SVI ',.qA� L16ql'
<br />................................ . ............... . . ........ . . . . . ..... . ................... . ................. . . .. . .................... . ...................................... .. .. .. . ..................................................................... ......................
<br />ACORD 25 (2016/03) Q 1988-2015 ACORD C 9,70RATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />ER -,I
<br />
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