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ACOIR CERTIFICATE OF LIABILITY INSURANCE GATE IMM ODlYYVY)
<br />ti1
<br />...�"' 2/07/2017
<br />THIS CERTIFICA'T'E 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(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 />PRODUCER °""'LD1 Mike
<br />NAME:
<br />Michael ftadgiak(971832A) (AIc Na Fxp 949-753 9555...._._..... PPC Np)p_. _. ..
<br />196 TechnologyDr Ste B N-2018-025 EMAIL - _
<br />AD�rgEs� ?Rrad9tck@fersEgerit.DUm � � � _
<br />INSURER15LAFFOROING COVERAGE NAit
<br />Irvine CA 92618-2433 INSURERA Truck Insurance ExchgNG _ 29709
<br />INSURED w INSURERS: Farmers insurance Exchange 21652.
<br />SANTA, ANA BUSINESS COUNCIL, INSURERS Mid CenturyInsurance Comperes_ 21687
<br />400 E. 4TH STREETIitmi e6R n. State Fund C
<br />31194
<br />901t17DIOA#737iilyfiT_iii 1111[ La is . , :, = r
<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
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />SANTA ANA CA 92701
<br />INSRi _ ---------
<br />TYNE OP INSURANCE POLICY NUMBER
<br />PdIiCY EFF I POLICY EXP "'v _.�..�_.
<br />' (MMIDONYYYI. (MMIOONYYY) LIMITS
<br />GENERALLIABIDTY
<br />EACH OCCURRENCE '$
<br />1,000,000
<br />X COMMERCIALGENERALUABILITY
<br />AMkORTORENTED
<br />rv--I
<br />Phi EMISSESS,(e_n wimpoonce}-.,� S
<br />1000000
<br />( I CLAIMS MAGE ^J OCCUR x
<br />MED EXnmy onefarsgo) $
<br />.
<br />10,990
<br />B Y N 805503390
<br />I
<br />121071201711210712018
<br />--i
<br />PERSONALS, ADV INJURY 1$
<br />�1$
<br />_
<br />1,000 000_
<br />GENERAL AOGREGATE
<br />2,090 080
<br />GENL AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS-COMPIORAGG IS
<br />2,009099
<br />PRD LOC
<br />POLICY
<br />irD.
<br />( ___ �,..$
<br />AUTOM09ILE LIABILITY I
<br />COMBINED SINGLE LIMIT 1
<br />$BT a,cidenl s
<br />1,0001000
<br />I ANY AUTO
<br />BODILY INJURY (Per persue) ) $
<br />f
<br />—' ALLOWNED SCIEDULEO
<br />B ,AUTOS ! AUTOS 605603396
<br />`—
<br />12107/2017 12/07/2018
<br />UR
<br />BODILY INJURY (Per Puri$
<br />NON OWNED
<br />HIRED AUTOS
<br />_ �-_AUTOS
<br />-ROPER --U'-- C- - !
<br />. S
<br />...(_4J,„ltla?Ll_ I
<br />- -�
<br />__
<br />—I
<br />$
<br />UMBRELLA LIAa OCOUR I
<br />`
<br />- EACH OCCURRENCE is
<br />_
<br />EXCESS U
<br />.,._-Ae '� GLAIMS-M11AOE1
<br />1 l
<br />- AGGREGATE I $
<br />e. _-_ -----------
<br />RETENTIONS
<br />h
<br />WORKERS COMPENSATION
<br />) f
<br />WC STATU IgTH-�
<br />AND EMPLOYER5'LIAHILITY Y!N
<br />-.LT& IMITy 1
<br />.ANY PROPRIETORIPARTNERlEXECUTIYE
<br />D I OFF CERSMEMBER EXCLUDED? ❑_NIA' ` 90813$4
<br />'_:12/10/2617112(10/2016
<br />-ELEACHACCIOENT is
<br />— —
<br />1,006,090
<br />--
<br />I(MantlatnryinNHl
<br />j
<br />IE.L DISEASE - EA EMPLOYEE"$
<br />1,069,000
<br />jlf Yes, tln6dha cunder
<br />DESCRIPTION OF OPERATIONS Iesipw I
<br />I
<br />ELDISEASE, POLICY LIMITIS
<br />_
<br />1,909,099
<br />Fidelity Bond
<br />5,000 SIR
<br />$600,000
<br />E D&O 106032811
<br />< EPL
<br />:1211012017:12110120181
<br />1,000 SIR
<br />$1,000,000
<br />1,000 SIR
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUach ACORD 101, Additmard Remarks Schedule, If more space Is required)
<br />400 E. 4TH STREET, SANTA ANA, CA 92701
<br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS
<br />ARE NAMED AS ADDITIONAL INSUREDS FOR GENERAL LIABILITY
<br />PURPOSES. COVERAGE IS PRIMARY AND NON-CONTRIBUTORY, WITH THIRTY
<br />(30) DAYS NOTICE_ OF CANCELLATION, EXCEPT 10 DAYS FOR '..
<br />NONPAYMENT OF PREMIUMS
<br />CERTIFICATE HOLDER CANRFI I ATIi IM
<br />AL:URU i5 (1U7D/U5) CC)1988-2010 ACORD CORPORATION, All 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 ANA CA 92701
<br />AUTHORIZED REPRESENTATIVE
<br />AL:URU i5 (1U7D/U5) CC)1988-2010 ACORD CORPORATION, All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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