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'ate a CERTIFICATE OF LIABILITY INSURANCE 12/07/2017
<br />THIS 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 pollcy(los) 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 andorsement(s).
<br />PRODUCER
<br />CONTACT Mike
<br />NAME'
<br />Michael Rodgick(971832A)
<br />PHONE
<br />NC Ne Exq 949-753 9555_ .,,.._ jac wo);__,_
<br />196 Technology Dr Ste B
<br />EMAIL "-
<br />gpQg�ss m[odgiCkQfaDna[sa9Bnt.Com
<br />REDUCED BY
<br />INSURER (S).Ar-FORDING COVERAGE NAIC#
<br />Irvine CA 92618-2433
<br />INSURERA: Truck Insurance Exchange 21709
<br />INSURED
<br />INSURER a Farmers Insurance Exchan e--
<br />r
<br />SANTA, ANA BUSINESS COUNCIL,iNSVRER
<br />C_ _. Mid. Cenlot Insurance Company_ 21687
<br />400 E. 4TH STREET�-
<br />_
<br />INsu@ERa State Fund
<br />RENTED —'i— - - ....._
<br />INSURER E: Travelers Insurance 31j94 -
<br />SANTA ANA CA 92701
<br />1 INSURER F.��
<br />COVERAGES
<br />CERTIFICATE NUMBER:
<br />REVISION NUMBER -
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN
<br />ISSUED TO
<br />THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY
<br />CONTRACT
<br />OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TI4E INSURANCE AFFORDED BY
<br />THE POLICIES
<br />DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN
<br />REDUCED BY
<br />PAID CLAIMS.
<br />RANO - `QDDL SU BRRwentF,
<br />LTR TYPE OF INSURANCE I
<br />LTRPtlLiCY NUMBER
<br />POP"'S
<br />MMIOOIYYYYf
<br />Pd"GYEXP�— '-
<br />1112 IYYYY) LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE I $ 1,000X0
<br />i (
<br />x COMMERGAL GENERAL_UABILI7Y
<br />1[5AEiM0
<br />RENTED —'i— - - ....._
<br />X 1
<br />Pft ISES Ea c,xi ra ce 5 1000000
<br />If
<br />CLAIMS MADE , OCCUR
<br />Y N 605503396
<br />112107/2017
<br />(
<br />MEO Ext LAeIy eno Person) 1$ 10,000
<br />12/07/2018 1 I
<br />PERSONAL&AOVINJURY i 5 1,000,000
<br />1
<br />GENERAL AGGREGAfr S 2,000000
<br />GENL AGGREGATE LIMIT APPLIES PER
<br />PRO
<br />POLICY LOC
<br />) PRODUCT3._COMP(OPAGO_ $ 2,000,000
<br />,AUTOMOBILE LIABILITYCOMBINED
<br />SINGLE LIMIT
<br />1,000 000
<br />ANY AUTO
<br />BODILY WJURY (Per N enn) $
<br />B ALL OWNED _SCHEDULED ! 605503396
<br />_. AUTOS �. AUTOS :
<br />12/07/2017
<br />12107/20181 BODILY INJURY Per amidenl s
<br />( )
<br />,I
<br />I NON�OWNED
<br />HIRED AUTOS �X AUTOS j
<br />4
<br />PROPE RTY DAMAGC `- --' -
<br />;(Per acm9nnt)__ L5
<br />r
<br />_. UMBRELLA LIAR I OCCUR
<br />1 EACH OCCURRCPICE
<br />I S
<br />ESS WA CLAIMS AADE I
<br />I
<br />I IAGGR GATE
<br />I g
<br />DEDRETENTIONS
<br />i
<br />�
<br />3
<br />_
<br />'WORKERS COMPENSATION1
<br />AND EMPLOYERS'LIABILITYYIN 1
<br />vI WC S7ATU LOTH
<br />:n 'LOSYllMITSI 1 EH,I,-.
<br />'
<br />. ANY PROPRIETORIPARTNENEXECUTIVE
<br />D
<br />E L EACH ACCIDENT
<br />DENT
<br />___
<br />' 1,000 000
<br />is
<br />OFrtcERlMEMBER EXCLUDED9 � NIa� 9081384
<br />12/10120171
<br />12/10/2018
<br />_._
<br />(Mandatory in NH)
<br />Ryes, desa,leunder--;--
<br />EL DISEASE -EA EMPLOYEN'g
<br />1,000000-
<br />;pESCRIPHIGH OFOPERATIONS eelwr
<br />j IE.L. OISEASE- POLICY LIMIT
<br />IS 1,000,000-
<br />Fidelity Bond
<br />( 5,000 SIR $500,000
<br />E D&O 1 106032811
<br />112110/2.017'
<br />12/1012018 1,000 SIR $1,000,000
<br />',.. EPL
<br />! 1,000 SIR $1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Addltlanal Rurnerks Schedule, If mom spaco le mquimd)
<br />400 E. 4tH STREET, SANTA ANA, CA 92701
<br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL LIABILITY
<br />PURPOSES. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY, WITH THIRTY (30) DAYS NOTICE_ OF CANCELLATION, EXCEPT 10 DAYS FOR
<br />NONPAYMENT OF PREMIUMS
<br />CERTIFICATE HOLDER CANCELLATION
<br />ACORD 25 (2010105) © 1988.2010 ACORD CORPORATION. ASA rights reserved.
<br />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 PLZ
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />SANTA APIA CA 92701AUTHORIZED
<br />REPRESENTATIVE
<br />ACORD 25 (2010105) © 1988.2010 ACORD CORPORATION. ASA rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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