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A� D® CERTIFICATE OF LIABILITY INSURANCE
<br />2/2/2018/DDmml
<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 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 endorsement(s).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insurance Brokers of CA. LIC. # 0726293
<br />505 N Brand Blvd, Suite 600
<br />CONTACT Mei Cha
<br />PHONE 818.539.8628 FAX .818.539.8728
<br />E-MAIL
<br />. Mei_chan@ajg.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />Glendale CA 91203
<br />INSURER A: Berkley National Insurance Company 38911
<br />INSURED INTEHOU-03
<br />INSURER B:NewYork Marine And General Insurance 16608
<br />Interval House
<br />P.O. Box 3356
<br />INSURER C:
<br />Seal Beach, CA 90740
<br />INSURER D:
<br />INSURER E
<br />NSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1071070208 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 INSURANCEADDLSUBR
<br />INSD
<br />MID
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDIYYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />HHS8525626-11
<br />10/1/2017
<br />10/1/2018
<br />EACH OCCURRENCE $1,000,000
<br />CLAIMS -MADE ❑X OCCUR
<br />DA A ET RENTED
<br />PREMISES Ea occurrence $100,000
<br />MED EXP (Any one person) $5,000
<br />PERSONAL &ADV INJURY $1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />GENERALAGGREGATE $3,000,000
<br />X POLICY JECT LOC
<br />PRODUCTS - COMP/OP AGO $3,000,000
<br />$
<br />OTHER'.
<br />AUTOMOBILE
<br />LIABILITY
<br />LE IMT $
<br />Ea accidenn t
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />OWNED ASCHEDULED
<br />AUTOS ONLY UTOS
<br />BODILY INJURY (Per acciaccident)$
<br />HIREDNLV NOWOWNEV
<br />PROPERTY DAMAGE $
<br />Peraccident
<br />A
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />HHN 8565362-11
<br />10/1/2017
<br />10/1/2018
<br />EACH OCCURRENCE $2,000,000
<br />AGGREGATE $2,000,000
<br />X
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED X RETENTION $0
<br />Sexual misconduct $Included
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />W0201800005078
<br />2/1/2018
<br />2/1/2019PER
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $1,000,000
<br />ANVPROPRIETOR/PARTNDED? CUTIVE
<br />RE%CLUDED? ❑N/A
<br />OFFICE(Mandatory
<br />E.L. DISEASE - EA EMPLOYE $1,000,000
<br />NH)
<br />InN
<br />if ns, describe
<br />Dyes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $1,000,000
<br />A
<br />Pmperty Coverage
<br />HHS8525626-11
<br />10/1/2017
<br />10/1/2018
<br />Limit: $4,589,200
<br />Deductible: $1,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
<br />Policy: Crime Coverage
<br />Policy Term: 12/01/2017 - 12/01/2018
<br />Policy Number: UC11717955.17-040
<br />Carrier: Underwriters at Lloyd's, London6*�1
<br />Employee theft :Limit : $2,000,000 /Deductible : $25,000
<br />ERISA: Limit: $2,000,000
<br />See Attached... t
<br />City of Santa Ana Community Development Agency (M-25)
<br />Administrative Services Division
<br />Attn: Terri Eggers
<br />20 Civic Center Plaza, M-25
<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 />AAAUTT,H�OppRIZE••D RE
<br />}"'4R.1Li as
<br />(S 1988.2015 ACORD CORPORATION_ All rinhts
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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