Laserfiche WebLink
A -nary- i -'),'S <br />A� oY <br />CERTIFICATE OF LIABILITY INSURANCE <br />11/MHMM1 o�Y) <br />4/2016 <br />--CHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />yERTIFICATE 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 />Arthur J. Gallagher & Co. <br />Insurance Brokers of CA. Inc. LIC # 0726293 <br />505 N Brand Blvd, Suite 600 <br />CONTACT <br />Annie Lee <br />PHONE FAx <br />( . 818-539-2300 D o.818-539-2301 <br />EMAIL .Annie_Lee@ajg.com <br />Glendale CA 91203 <br />INSURER(S) AFFORDING COVERAGE NAIL M <br />INSURERA:Great American Alliance Insurance C 26832 <br />PAC 5154660 <br />INSURED <br />INSURER B:GreatAmerican Insurance Company of 22136 <br />Orange County Conservation Corps <br />1853 N. Raymond Ave. <br />Anaheim, CA 92601 <br />INSURER c:Navi ators Insurance Company 42307 <br />INSURER D: <br />INSURER E: <br />X Abuse$1MM/$3MM <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 2111269631 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 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />IN SD <br />wo <br />POLICYNUMBER <br />POLICY EFF <br />MMIDDIYYYY) <br />POLICYEXP <br />flMWDD/YYYYI <br />LIMITS <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE XIOCCUR <br />Y <br />PAC 5154660 <br />10/1/2016 <br />10/1/2017 <br />EACH OCCURRENCE $1,000,000 <br />DAMA ETO RENTED <br />PREMISES E ... uffmdl $100,000 <br />MED EXP (Any one person) $5,000 <br />X Abuse$1MM/$3MM <br />PERSONAL &ADV INJURY $1,000,000 <br />GEN'LAGGREGATE UMITAPPUES PER: <br />POLICY [_] JERGT El LOC <br />GENERAL AGGREGATE $3,000,000 <br />PRODUCTS - COMP/OP AGO $3,000,000 <br />Professional Liab $1MM/$3MM <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />CAP -0991249 <br />10/1/2016 <br />10/1/2017 <br />COMBINEDIN $ <br />Eeeccident 1,000,000 <br />X <br />ANY AUTO <br />BODILY INJURY (Per person) $ <br />X <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />NON -OWNED <br />AUTOS <br />HIREDAUTOS NX <br />BODILY INJURY (Per accident) $ <br />PROPER DAMAGE <br />Peracaitlent $ <br />X <br />Camp $100 Coll $500 <br />- <br />$ <br />A <br />X <br />UMBRELLALIAB <br />X <br />OCCUR <br />UMB-5603795 <br />10/1/2016 <br />10/1/2017 <br />EACH OCCURRENCE $2,000,000 <br />EXCESS LIAR <br />GAIMS-MADE <br />AGGREGATE $2,000,000 <br />DED X RETENTION$10,000 <br />Is <br />1 <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETORIPARTNERIEXECUTIVE <br />OFFICERIMEMBER EXCLUDED? <br />NIA <br />PFR OTH- <br />STATUTE ER <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE S <br />(Mandatory In NHl <br />If yes, describe under <br />EL DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />C <br />A <br />Directors & officers <br />Auto Excess Coverage <br />NYI6DOLV03181NV <br />EXC-0991250 <br />10/1/2016 <br />10/1/2016 <br />10/1/2017 <br />10/1/2017 <br />Each Claim/Aggregate $2,000,000 <br />Limit $4,000,000 <br />DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORD 101, AddItional Remarks Schedule, may be attached If more space Is required) <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named <br />additional insured with respect to the operations of the named insured. Such insurance is Primary and Nan (Contributory. e <br />Community Development Agency M -2S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />Y P 9 Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS, <br />P.O. Box 1988 <br />Santa Ana CA 927021988 <br />USA AUTHORIZED REPRESENTATIVE <br />9gRR-9MA Ar.non rn POnPATInk! All Al hfl .men ,4 <br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD <br />