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A & CERTIFICATE OF LIABILITY INSURANCE
<br />-DATE
<br />17D I
<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(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 />Edgewood Partners Ins. Center
<br />License Number- OB29370
<br />PO Box 13847
<br />Sacramento CA 95853 N-2017-113
<br />CONTACT NAME.Heather Crane
<br />PHONE g16-974-4617 FAX
<br />E-MAIL
<br />. heather.crane@epicbrokers.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC q
<br />INSURER A:Travelers Property Casualty Cc of
<br />25674
<br />6307704AI97
<br />INSURED COOPPERS
<br />INSURER B:Lloyds of London
<br />85202
<br />Cooperative Personnel Services
<br />DBA: CPS HR Consulting
<br />241 Lathrop Way
<br />INSURER C:
<br />CLAIMS -MADE OCCUR
<br />INSURER D:
<br />INSURER E:
<br />Sacramento CA 95815
<br />INSURER F :
<br />-DAMAGE RENTEp
<br />PREMI
<br />PREMISESS Ea occurrence
<br />$500,000
<br />COVERAGES CERTIFICATE NUMBER: 16787200 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 />R
<br />I�TR
<br />TYPE OF INSURANCE
<br />ADDE
<br />NSD
<br />SUIRTIT_
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />O
<br />MMDNYYY
<br />M/ D NYYY
<br />M
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />6307704AI97
<br />7/1/2017
<br />7/1/2018
<br />EACH OCCURRENCE
<br />$1,000,000
<br />CLAIMS -MADE OCCUR
<br />-DAMAGE RENTEp
<br />PREMI
<br />PREMISESS Ea occurrence
<br />$500,000
<br />X
<br />MED EXP (Any one person)
<br />$10,000
<br />DeduCtiblle'$0
<br />PERSONAL &ADV INJURY
<br />$1,000,000
<br />LIMIT APPLIES PER:
<br />POLICY JECT LOC
<br />GENERALAGGREGATE
<br />$2,000,000
<br />GEN'LAGGREGATE
<br />PRODUCTS - COMP/OP AGO
<br />$2,000,000
<br />$
<br />OTHER:
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />BA7704A197
<br />711/2017
<br />7/1/2018
<br />COMBINED SINGLE IT
<br />Ea accident)
<br />$ 1,000,000
<br />ANYAUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED SCHEDULE
<br />AUTOS AUTOS
<br />LY INJURY Per accitlentD BODI
<br />( )
<br />$
<br />_
<br />X
<br />HIRED AUTOS X NON -OWNED
<br />AUTOS
<br />PROPERTYDAMAGE
<br />Per accident)
<br />$
<br />$
<br />A
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />CUP3J482477
<br />7/1/2017
<br />7/1/2018
<br />EACH OCCURRENCE
<br />$6,000,000
<br />X
<br />EXCESS LAS
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$6,000,000
<br />DED X RETENTION$n/a
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y/N
<br />UB1176A220
<br />7/1/2017
<br />7/1/2018
<br />PER OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />ANVETOR/PARTNEEEXECUTIVE ❑
<br />EXCLUDED4
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />(MandatryinNOFFICER/MEMBER
<br />(Mandatory in NH)
<br />If yes, describe
<br />DESCRIPTION OF OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT
<br />$1,000,000
<br />B
<br />A
<br />Prof Liab- Claims Made
<br />Retro Date - 10/13/1989
<br />WlBDC5170301
<br />UB1176A220
<br />7/1/2017
<br />7/1/2017
<br />7/1/2018
<br />7/1/2018
<br />Per Claim/Agg $5,000,000
<br />Deductible Per Claim $75,000
<br />Stop Gap - Only ND, OH, WA, WY
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
<br />RE: Job: Test Site Rental. When required by written contract, Additional Insured status with primary coverage applies to General Liability and
<br />Automobile Liability and Waiver of Subrogation applies to General Liability, Automobile Liability, and Workers' Compensation, all per the
<br />attached endorsements.
<br />CERTIFICATE HOLDER CANCELLATION
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />20 Civic Center Plaza M-24
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Santa Ana, CA 92707
<br />AUTHORIZED REPRESENTAA�T,,I,,VV,E
<br />��yp
<br />©1988.2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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