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®® CERTIFICATE OF LIABILITY INSURANCE <br />DATEIMMIDDYYYY) <br />11/14/2017 <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 'L1�q� nx <br />Tr ftp A ylq- "J I )'9 ICC <br />MOC Insurance Services ��J <br />License No. 0589960 A-20IS- U3'i <br />44 Montgomery St., 17th Fl. q <br />N-oRu F'^'7 <br />San Francisco CA 94104 P' Y �7 V7 <br />CONTACTHalides Ca11e'as <br />NAME: J <br />PHONE (415) 957-0600 FAX <br />No: (415)957-0577 <br />E-MAIL hcallejas@mooins. corn <br />INSURERS AFFORDING COVERAGE NAICp <br />INSURER A Mas sachusette Bay Ins. Co. 22306 <br />INSURED <br />Keyser Marston Associates, Inc. <br />a1w I9I�0 <br />1299 4th Street, Suite 408 1 O <br />San Rafael CA 94903 ) J <br />INSURER INSURER e Allmerica Financial Benefit Co. 41840 <br />INSURERC:Hanover Insurance Company 22292 <br />tNSURERD:Re ublic Indemnity Company of 43753 <br />INSURER E: <br />INSURERF: <br />COVERAGES CERTIFICATE NUMBER2017-2018 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 />ILTR <br />TYPE OF INSURANCE <br />ADDL <br />B <br />POLICY NUMBER <br />POLICY EFF <br />M LIC YYYY <br />POLICY EXP <br />FOLIC YYYY <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />Halides Callejas/HCA <br />EACH OCCURRENCE $ 1,000,000 <br />A <br />CLAIMS -MAGE X OCCUR <br />DAMAG TOREN D 500,000 <br />PREMISES Ea occurrence $ <br />MED EXP (Any one person $ 10,000 <br />X <br />ZDFA49104903 <br />12/1/2017 <br />12/1/2018 <br />PERSONAL &ADV INJURY $ 1,000,000 <br />No Deductible Applies <br />GENL AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE 2,000,000 <br />POLICY I JECT D LOC <br />__$ <br />PRODUCTS - COMP/OP AGO $ Included <br />OTHER; <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLELIMIT $ 1,000,000 <br />Ea acGdent <br />BODILY INJURY (Per person) $ <br />B <br />X ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />X <br />AWA49004903 <br />12/1/2017 <br />12/1/2018 <br />BODILY INJURY (Per acddant) $ <br />Pere cltlenl AIdAGE $ <br />X HIRED AUTOS X NON-OWNEp <br />AVi05 <br />Uninsured motorist combined $ 1,000,000 <br />X Comp$500 X CA $500 <br />X <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 4 000 000 <br />AGGREGATE $ 41000,000 <br />C <br />EXCEBSLIAB <br />CLAIMS -MADE <br />DIED X RETENTION 0 <br />$ <br />X <br />USFA49117103 <br />12/1/2017 <br />12/1/2018 <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY YIN <br />ANY PROPRIETORIPARTNER/EXECUTIVE <br />PER <br />X MATUTE I I EERH <br />EACH ACCIDENT $. 1000,000 <br />EL 1 <br />D <br />OFFICERIMEMBER EXCLUDED? ❑NIA <br />(Mandatory in NH) <br />3954623 <br />12/1/2017 <br />01/01/2018 <br />- — <br />E.L. DISEASE -EA EMPLOYE $ 1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT s 1,000,000 <br />C <br />Professional Liability <br />=42616500 <br />12/1/2017 <br />12/1/2018 <br />Each Wrongful Act $1,000,000 <br />Retention $25,000 <br />Retro Date: 11/11/1976 <br />Aggregate Limit $2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) <br />City of Santa Ana, City of Santa Ana Acting as Successor Agency and/or Housing Authority of the City of <br />Santa Ana, its officers, employees, agents, volunteers and representatives are Additional Insured with <br />respects to the Insured's operations. Insurance provided is Primary and is not contributory with any <br />other insurance carried. 30 Day Notice of Cancellation/10 Day for nonpayment of premium. <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2014/01) <br />INS025 (20140) ) <br />©1988-2014 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 <br />BE DELIVERED IN <br />Executive Director of CDA <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza M-25 <br />AUTHORIZED REPRESENTATIVE <br />Santa Alla, CA 92701 <br />Halides Callejas/HCA <br />ACORD 25 (2014/01) <br />INS025 (20140) ) <br />©1988-2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />