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- ``coR °® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/Y11YY) <br />�_ 10/10/2011 <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 INSU RER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIO 1 th¢,policy(ies) must be endorsed_ If SUBROGATION IS WAIVED, subject to <br />the teens and conditions of the policy, certain policies may regL� alKtijngent. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsements . <br />PRODUCER % - - <br />_ b <br />Ruther£oo rd (� - <br />222 Central Park Avenue - <br />Suite 1340 <br />N <br />� FAX <br />:7 7- - A/c No :7 - - <br />L <br />A ss: <br />INSURERS AFFORDING COVERAGE <br />NAIC# <br />V1rg 1n1a Beach VA 23462 <br />INSURER A <br />Y <br />P09B2903B01 <br />INSURED <br />INSURER B <br />EACH OCCURRENCE <br />INSURER G: <br />PREMISES Ea occurrence <br />MuniServiCes, LLC <br />Attn: Patricia Dunn <br />ph: 559 -271 -6852 <br />INSURER D: <br />'7 <br />7335 N. Palm Blu££s Ave. <br />INSURER E: <br />MED EXP (Any one parson) <br />INSURER F. <br />PERSONALSADV INJURY <br />Fresno CA 93711 <br />COVERAGES CERTIFICATE NUMBER: 384690176 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 />INSR <br />LTR <br />TYPE OF INSURANCE <br />IN R <br />WVD <br />POLICY NUMBER <br />POLICY EFF <br />MM /DD/YYW <br />POLICY EXP <br />MM /DD/YYYY <br />LIMITS <br />C <br />GENERAL LIABILITY <br />Y <br />Y <br />P09B2903B01 <br />10/31/2011 <br />0/31/2012 <br />EACH OCCURRENCE <br />$1,000,000 <br />PREMISES Ea occurrence <br />$300,000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />MED EXP (Any one parson) <br />$10, 000 <br />PERSONALSADV INJURY <br />$1, 000, 000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT AP PLIES PER: <br />PRODUCTS - COMP /OP AGG <br />$2, 000, 000 <br />POLICY PRO LOC <br />$ <br />C <br />AUTOMOBILE <br />LIABILITY <br />HAP9B2902101 <br />10/31/2011 <br />0/31/2012 <br />Ea accitlen[ <br />1, 000 000 <br />X <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per eccitlent) <br />$ <br />X <br />HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />$ <br />D <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />UMH9 8290 ?901 <br />10/31/2011 <br />0/31/2012 <br />EACH OCCURRENCE <br />$10, 000, 000 <br />AGGREGATE <br />$10, 000, 000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />DED RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATON <br />AND EMPLOYERS' LIABILITY Y / N <br />Y <br />0982903901 <br />10/31/2011 <br />0/31/2012 <br />X WC STATU- OTH- <br />E.L. EACH ACCIDENT <br />$1, 000, 000 <br />ANY PROPRIETOR /PARTNER /EXECUTIVE � <br />OFFICER /MEMBER EXCLUDED? N <br />N / A <br />E.L. DISEASE - EA EMPLOYE <br />$1 , 000, 000 <br />(Mandatory In NH) <br />If yes, tlascribe untlar <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />$1 , 000, 000 <br />/'' <br />H <br />Professional Liab (E &O) <br />Crime <br />216'11630008 <br />CP006253306 <br />10/31/2011 <br />10/31/2011 <br />0/31/2012 <br />0/31/2012 <br />$5,000,000 Limit <br />$5,000,000 Limit $25,000 Dad <br />DESCRIPTON OF OPERATONS / LOCATON$ /VEHICLES (Attach ACORD 101, AddRlonal Remarks Schedule, If mono apace is requinod) <br />Per the cancellation wording listed on this form, the policy provisions include at least 30 days notice o£ <br />cancellation except £or non - payment o£ premium. <br />The City o£ Santa Ana, its agents, officers, servants and employees are named as additional insureds under <br />the General Liability policy with respect to the operations and work performed by the named insured as <br />required by contract. <br />GEK I IFIGA 1 E F10LUEK 'w °� f ( GANG ELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Santa An ° -- � - Z ACCORDANCE WITH THE POLICY PROVISIONS. <br />Attn: Finance Director Laura ti :..� SF:��cdy <br />20 Civic Center P1a Za ^, v;lsldnl. C�tly �1 [i. �J l"; �. `. AUTHORIZED REPRESENTATVE <br />Santa Ana CA 92702 -1988 ��� � �""` <br />© 1988 -20'10 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />