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V CERTIFICATE LIABILITY INSURANCE DAM (MhVQ0rfYYY3
<br />12/0712016
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TSI SS
<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 INSUIRER($), AUTHORIZEt)
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUS–R–O ATION IS WAIVED, subject to
<br />the terms and conditions of the policy, pertain policies may rewire an endorsement. A statement on #his certificate doss not confer rights to the
<br />certificate holder in lieu of such endorsement(s),
<br />PRODUCER C NTACT Mike
<br />FF,..
<br />Michael Rodcgick(971832A) ,.sa1149T53 95x5 is
<br />PAX
<br />196 Tectlnolrsgy Or Sts 8 AW)RES&: rnm(InInknry f;;r nRrRRnRnt mm
<br />Irvine__ CA 92618-2433 INSURFRA: Truck Insurance Exchan : M_.. 1709
<br />INSURER — - - ma__ _ INSURER 0: Farmer Insurance Exchange ................�._� 21652
<br />SANTA, ANA BUSINESS COUNCIL, INSURER C„z MW Cain€u insurance Carl an ._....___ ~
<br />_ _�__._._.w.._dmP_Y � 21687
<br />400 E. ATM STREET INSURgfk R'
<br />INSURER E
<br />SANTAANA CA 92701 INSURERFa
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />IN CY 60POLICY KXF I - ... ._....................�
<br />L7R TYPEpFIN$URANCE ! I POUCYNU ER pam DD Llrxlrm
<br />? WNERALIJASILITY
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<br />EACH OCCURRENCE Is
<br />i i COMM tCIAI GENERAL LIASILRY
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<br />; � eO1.s�1i7�,laC�I3
<br />! I nR SES nce $ '��Ii�i 000
<br />GLAIt95AiApE cif I accuR
<br />I r�cnl xP "Its n„ r ] ! s 1€1,00
<br />B ' Y
<br />N '; S(15aQ3396 '
<br />12107QO16 12107/2097 PERSONAL &ADV INJURY !$ 1,000,000
<br />..�•
<br />GENERALAGGREGATE. ...OPe.e 2,000,000
<br />�
<br />1 :SEN`L AGGREGATE LIWAF'Pf.IES PERz
<br />I'I�gCi�1C79 CC3idW1pP AGES a 2,000,000
<br />I PRO-
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<br />POLICYJEQT LOG
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<br />! AUTOMOBILE LIABILITY
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<br />CONICINED SINGLE UNIfT
<br />dent �lt�fl QI i3
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<br />ANY AUTO �
<br />1 BODILY INJURY (Par person)
<br />ALL OWNED SCHEOVIFita.
<br />B ' Auras ! ? AUTOS €
<br />; 605503396
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<br />1210712016 112107/2017 I BODILY INJURY (Pin acddant)
<br />11 I NON-OW14Eq
<br />I HIRED AUT05 I� -l! j AUTOS
<br />PROPERTY DAMAGE
<br />Uh1aRcLL11LiAET OCCUR i
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<br />� i !I EACHO=RRENCE
<br />EXCE6�5UAS CLAIMS-MADC
<br />AGGREIJATE S
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<br />DEp R! rENTION$
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<br />pMPENSATION
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<br />AND EMPLOVERSLIABILtre YIN,
<br />tANYPROPRIETOMPARTNERIEXECLMVE
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<br />E.L EACH ACCIDENT � S
<br />'sOFFI FUMEMSER EXCLUDED N{A
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<br />; (Mandatory In NHI
<br />F.L. DISEASE -EA EMPLOYE_N S
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<br />DE9GExi'Tlf}N OF L7PE'f2RT125 btlivEvt
<br />I I EL. DISEASE - POLICY uurr S
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<br />MCRIig ON OF OPERATIONS I LOCATIONS I VEHICLES lAlipnh ACORa 101, Addidonal eleanaft Schedule, if mora epnee W mqulraad)
<br />400 E. 4TH STREET, SANTA ANA, CA 92701
<br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL LIABILITY
<br />PURPOSES. COVERAGE I, PRIMARY AND NON-CONTRIBUTORY, WITH THIRTY (30) DAYS NOTICE OF CANCELLATION, EXCEPT 10 DAYS FOR
<br />NONPAYMENT OF PREMIUMS
<br />COMM,
<br />SHOULD ANY OF THE ABOVE DESCRI13ED POLICIES BE CANCELLED BEF0RE
<br />CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN
<br />20 CIVIC CENTER PLZ ACCORDANCE WITH THE POLICY PROVISIONS.
<br />A1,11HU EI) REPRESENTATIVE
<br />SANTA ANA CA 92701 I-)
<br />@ 1988-2010 ACO RD COR148 iYATION. All rights
<br />The ACORN? name and logo are registered marks of lACORD
<br />
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