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ACC-Mbr CERTIFICATE OF LIABILITY INSURANCE
<br />11
<br />DATE(MMIDDfYYYY)
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„ THE hNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />8/24/2017
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO'LD'ER. 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(les) 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 Nicole L:uby
<br />NAME"...-.....
<br />Excelsure Insurance Services
<br />.........
<br />FAX
<br />PHONo,_E..xt1: (800) 987-5051 IAfX,Ngl (877)987-5051
<br />18377 Beach Blvd Ste 325
<br />EMAIL nl,ub excels'ure.cam
<br />ADDRESS:
<br />6,2
<br />_ ... INSURER(S) AFFORDING COVERAGE ._ NAIC if
<br />Huntington Beach CA 92648
<br />INSURERA:Mt Hawley Insurance Company 137974
<br />INSURED_..- !L n�
<br />"L..,. P
<br />G
<br />INSURERB:Wer3t American Insurance Com an 44393
<br />p y
<br />Superior Property Services, Inc, �4
<br />� „
<br />INSURERC:StarStone National Insurance 25496
<br />- _ .....
<br />9129 Perkins St
<br />1 ('jC�
<br />-
<br />RD:Cypre
<br />INSUREss Insurance Company, (CA) 10855
<br />.... _
<br />,..+... 1 r..T
<br />E.L. DISEASE - EAEMPLOYEFI $ 1,000,000
<br />Pico Rivera CA 90660 t`
<br />"
<br />INSURER E t
<br />DESCRIPTION OF OPERATIONS below ' '
<br />INSURER .F:
<br />COVERAGES CERTIFICATE NUMBER:CL1762105758 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 WHICHTHIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„ THE hNSURANCE 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 />—.
<br />IL.TR TYPE OF INSURANCE ADDL SUER ___-- POLICY EFF POLICY EXP ...... _.__ ....................
<br />I POLICY NUMBER MMlDDlYYYY MM1DDfYYYY) LIMITS
<br />X COMMERCIAL GENERAL LIABILITY '..... EACH OCCURRENCE $ 1,000,000
<br />A I_ CLAIMS MAGE .,.. X IOCCUR DAMAGE TO RENTED ................50.000 '....
<br />_ - PREMISES (Ea occurrence), $ .............
<br />MGLO186215 i 6/22/2017 6/22/2018 MED EXP (Any ons person) 5 5, 000".
<br />_.
<br />-_ .. ..... ........ PERSONAL &ADV INJURY 1 5 1,000,000..
<br />....
<br />GEN 'LAGGREGATE .LIMIT APPLIES PER� GENERALAGGREGATE $ 2F
<br />I'll,,000,000
<br />PRO-
<br />POLICY X LOC 2,000,000
<br />JECT PRODUCTS - COMP/OP AGG $
<br />1 OTHER_ $
<br />1
<br />COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY $ 3-000,000
<br />X ANY AUTO BODILY INJURY (Per person) $-
<br />B
<br />ALL OWNED SCHEDULED
<br />AUTOS —1AUTOS BAW56589876 6/22/2017 6/22/2018 BODILY INJURY (Per accident) $
<br />HIRED AUTOS I AUTOS ,.5
<br />NON -OWNED PROPERTY DAMAGE
<br />�.. j �Peraccident).,.,.. .... ......_—.
<br />I1 Uninsured motonstcombined $ 1,000,000
<br />UMBRELLA LIAR 'l
<br />OCCUR� EACH OCCURRENCE $ 2,000,000
<br />...
<br />1
<br />c X j.. EXCESS LIAB j CLAIMS -MADE i AGGREGATE $ 2,000,000
<br />DED 1 RETENTIONS 86538Y170AL2 6/22/2017 6/22/2018 $
<br />WORKERS COMPENSATION
<br />PER CTH- --
<br />ANI? EMPLOYERS' LIABILITY Y I N
<br />`X I STATUTE, 0 1
<br />ANY PROPRIETORIPARTNERFE'XECUTIVE� �
<br />OFFICERIMEMDER EXCLUDED? Y N f A
<br />E.L. EACH ACCIDENT I $ 1,000,000
<br />.... -, -. 1
<br />D (Mandatory in NH) SUWC818935 6/22/2017 6/22/2018
<br />E.L. DISEASE - EAEMPLOYEFI $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below ' '
<br />� E.L. DISEASE - POLICY LIMIV� $ 11000,000
<br />I
<br />I . ` er.
<br />�j 10
<br />i 4�
<br />DESCRIPTION OF OPERATION'S f LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mere space Is regal
<br />dare
<br />The City of Santa Ana, it's officers, employees, agents, and represent additi insureds when
<br />you have agreed, in a written contract or written agreement, only with espects to Feral Liability,
<br />Umbrella and Business Auto as per business liability coverage forme CG 20 33 04 '' �,`j 0. 7 04 13 and CA
<br />88 10 01 13. Primary and non-contributory wording is included as per form C waiver of
<br />subrogation is included regarding the General Liability as per form CG 2 4
<br />%jr—r*, 1 irik M f r— rtvt_tJC:M tANtr�tLLA I IUN
<br />City of Santa Ana
<br />Attn: PRCSA,
<br />20 Civic Center Plaza M-23
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Nicole Luby/NJL
<br />@ 1988-2014 ACORD CORPORATION.. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />
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