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ACC)/t& CERTIFICATE OF LIABILITY INSURANCE
<br />DATEIMMIDDIYYI'YI
<br />8/24/2017
<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($), 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 />NAME: Ni Cele Luby
<br />Bxnelsure Insurance ServiceB(AIC
<br />PHDNE (800)987-5051 FAX o I (877)1. 9875051
<br />N
<br />18377 Beach Blvd Ste 325
<br />_..
<br />E-MAIL
<br />DDRIESS: nluby@excel sure. com
<br />t) y t
<br />ciV�
<br />-INSURERuAPPORDING COVERAGE _ I
<br />Huntington Beach CA 92648(L j_ `>,, ..
<br />_NAICM __
<br />INSURERA Mt Hawley Insurance Company .37974
<br />INSURED
<br />INSURERs:Wast American Insurance Company 44393.._
<br />Superior Property Services, Inc r
<br />t' 5 1 f "i .t ill
<br />INSURER o:StarS tone National Insurance 25496
<br />9129 Perkins St
<br />_r ('_�^
<br />L I�
<br />INSURER D Cypress Insurance Company (CA)..... -_ 10855
<br />Pi-r>t(.-I�
<br />(. P
<br />L-IC
<br />Pico Rivera CA 90660 t�%->'e.i:�}U
<br />INSURERE:
<br />'
<br />INBURERF:
<br />COVERAGES CERTIFICATE NUMRER-CL1762105758 REVICUTM 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 />(LTR TYPE OF INSURANCE - A150T-5IIs1E— POLICY SEE POLICYEXP
<br />POLICY NUMBER MMIODIYYYY MMIDO VY LIMITS
<br />X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE is 11000,000
<br />A CLAIMSMADEX
<br />_DAMAGE TO REN TE "-" ""---
<br />'. I OCCUR
<br />p g
<br />50, 000
<br />',, PREMISM�3-pgcurrenceJ II__. _
<br />NGL0186215 16/22/2017 6/22/2018MED EXP (Any onapomorn $ 5,000
<br />.._. ... __.._. ._.__.__. PERSONAL B ADV INJURY ',$ 11000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER: (GENERAL AGGREGATE '$ 2,000,000
<br />(POLICY X ;ECT LOC', PRODUCTS - COMP/OP AGO 'Is 2,000,000
<br />OTHER $
<br />AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s 1,000,000
<br />®
<br />(Eaeesc�aa—n1--- -_.---
<br />ANY AUTO __ - BODILY INJURY (Per person) 5
<br />^x'ALLO ED 'SCHEDULED BAWS6589876 5/22/2017 6/22/2018 BODILY INJURY(Perarclden0 — -�- --
<br />AUTOS
<br />NONAWNEO (PROPERTY DAMAGE
<br />HIRED AUTOS �_
<br />L__ AUT09 1 (per accident ®
<br />I. Uninsured motorist combined ;$ 11000,000
<br />UMBRELLA LIAR (OCCUR', EACH OCCURRENCE $ 2,000,000
<br />L.
<br />EXCESS LIAR .,yCtAIMG MADE :.AGGREGATE
<br />X.
<br />DEO ��RETENTION$ •86536Y170ALT 6/22/2017: 6/22/2018 'j$
<br />g O .
<br />WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY PER
<br />ANY PROPR ETORIPARTNERIEXECUTIVE STATUTl .__ ER ...__
<br />VIN EI EACH ACCIDENT $ 1,000,000
<br />OFFICERIMEMSER EXCLUDED? Y NIA
<br />D ,(Mandatory in NH) SUWC818935 .6/22/2017 6/22/2018 EL DISEASE - EA EMPLOYEE $_ 1, 000, C 0 0
<br />'4fea,desTION under E. L. DISEASE POLICY LIMIT $ 11000,000
<br />:DESCRIPTION OF OPERATIONS below
<br />dad ., A,A
<br />DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES IACORD 101, Additional Remarks Schedule, may be attuned it mom space Is requ�gqedf. ;
<br />The City of Santa Ana, it's officers, employees, agents, and represent�giZl are additio insureds when
<br />ds
<br />you have agreed, in a written contract or written agreement, only withee-spects to @%eral Liability,
<br />Umbrella and Business Auto as per business liability coverage forme CG 20 33 047 04 13 and CA
<br />88 10 Ol 13. Primary and non-contributory wording is included as per form C 0.V 4 waiver of
<br />subrogation is included regarding the General Liability as per form CG 2
<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 />Luby/NJL
<br />All rinhts reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />INS025 (201401)
<br />
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