|
AcoR ©� CERTIFICATE OF LIABILITY INSURANCE
<br />�'.
<br />DATE (MM /DDIYYYY)
<br />10/26/2010
<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 O�Rj NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS REPRESENTATIVE OR CERTIFICATE O-'Fy'`lSU N;COERFIFIC E119LDER.UTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the ify, (certain policies max;�rf.re an endorsement. A statement on this certificate does not confer rights to the
<br />=rsement(s).
<br />certificate holder in lieu of such
<br />PRODUCER
<br />Rutherfoord
<br />222 Central Park Avenue
<br />Suite 1340
<br />N CT
<br />NAME: Jaccfuie Joiner
<br />PHONE FAX
<br />A!C No Ext : - - A!C No : - -
<br />E -MAIL
<br />ADDRESS: JaC uie.Joiner @rutherfoord.com
<br />Virginia Beach VA 23462
<br />PRODUCER
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />EACHOCCURRENCE
<br />INSURED
<br />MuniServices, LLC
<br />Attn: Patricia Dunn ph: 559- 271 -6852
<br />INSURER A: Westchester Surplus Lines Insurance
<br />10172
<br />INSURER B: Fidelity & Deposit Company of Mar 1
<br />39306
<br />INSURER C:
<br />7335 N. Palm Bluffs Ave.
<br />INSURER D:
<br />$300,000
<br />Fresno CA 93711
<br />INSURER E:
<br />PERSONAL & ADV INJURY
<br />$1, 000, 000
<br />INSURERF: Zurich American Insurance Comipany
<br />COVERAGES CERTIFICATE NUMBER: 1940004863 REVISION NUMRER-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />ILTR
<br />TYPE OF INSURANCE
<br />A
<br />POLICY NUMBER
<br />MMIDDYIYYYY
<br />MMIDD //YYYY
<br />LIMITS
<br />F
<br />GENERAL LIABILITY
<br />Y
<br />Y
<br />CP09829038
<br />10/31/2010
<br />10/31/2011
<br />EACHOCCURRENCE
<br />$1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE K OCCUR
<br />DAMAGE( RENTED a occurrence
<br />PREMISES S E_
<br />$300,000
<br />MED EXP (Any one person)
<br />$10, 000
<br />PERSONAL & ADV INJURY
<br />$1, 000, 000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER.
<br />PRODUCTS - COMP /OP AGG
<br />$2,000,000
<br />POLICY PRO- L
<br />$
<br />F
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />CP09829038
<br />APPROVED
<br />10/31/2010
<br />S TO
<br />10/31/2011
<br />FORM
<br />COMBINED SINGLE LIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />—
<br />$
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />•
<br />HIRED AUTOS
<br />•
<br />NON - OWNEDAUTOS
<br />Laura
<br />tt Sheedy
<br />$
<br />QSS1sL8 C
<br />ty Attorney
<br />$
<br />F
<br />F�l
<br />BRELLA LIAR
<br />X _
<br />OCCUR
<br />UMB982907900
<br />10/31/2010
<br />10/31/2011
<br />EACHOCCURRENCE
<br />$10,000,000
<br />CESS LIAB
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$10,000,000
<br />D; cTl eLe
<br />$
<br />RETENTION $
<br />$
<br />F
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y! N
<br />ANY PROPRIETOR /PARTNER /EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED? N❑
<br />N/A
<br />Y
<br />WC9829039
<br />10/31/2010
<br />10/31/2011
<br />X WCSTATU- CER
<br />T M T
<br />E.L. EACH ACCIDENT
<br />$1, 000, 000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1, 000, 000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT
<br />$1, 000, 000
<br />DESCRIPTION OF OPERATIONS below
<br />A
<br />B
<br />Professional Liab(E &C)
<br />Crime
<br />021671630007
<br />CCP006253305
<br />10/31/2010
<br />10/31/2010
<br />10/31/2011
<br />10/31/2011
<br />$5,000,000 Limit $100,000 Ded
<br />$5,000,000 Limit $25,000 Ded
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Per the cancellation wording listed on this form, the policy provisions include at least 30 days notice of
<br />cancellation except for non - payment of premium.
<br />The City of Santa Ana, its agents, officers, servants and employees are named as additional insureds under
<br />See Attached...
<br />—� � VMIY VCLLNIIV IY
<br />City of Santa Ana
<br />Attn: Finance Director
<br />20 Civic Center Plaza
<br />Santa Ana CA 92702 -1988
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
<br />BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
<br />IN ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE •-�--
<br />U 1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
|