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MMC 10/16/2008 10:57:02 AM PAGE 3/006 Eastern Time Zone <br />DATE <br />L A RO CERTIFICATE OF LIABILITY INSURANCE 10115 M'°°""""' <br />0l1 &2008 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />4400 Commence Bank Tower HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />1717 Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Dallas, TX 75201-7357 <br />Attn: Gallas certsomarsh. com Fax 212-948-0519 <br />063185--AIh08.09 LA 06238 SM INSURERS AFFORDING COVERAGE NAIC # <br />INSURED �, -)G NSJRERA Insurance Company Of The State Of PA 19429 <br />Royal Street Communications, LLC �- 7-D' <br />2435 North Central Expressway, TI1200 INSURER a National Union Fire Ins Co Pittsburgh PA 19445 <br />Richardson, TX 75080 A--). 007-Og3 INSURER,' <br />A -tea i-D , INSURE R0 <br />IN11_RER E <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED <br />NOTWITHSTANDING ANY RCOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSONS AND <br />CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />N <br />LTB <br />ADDT1,� <br />INSRq <br />TYPE OF INSURANCE " PCUCYNUMBER <br />DUCT EFFECTIVE (POLICY EXPIRATION <br />DATE W IDDA'p DATE IMMIDWYY7 <br />LIMITS <br />GENERAL LIABILITY <br />t � 1 V.IJ Nl <br />q X <br />- <br />GL1871946 <br />OW01108 <br />09/01/09 <br />'AMA-`ET57 A ED <br />1,000,00 <br />X CO MMERC AL GENE RA11ABaITY <br />REM ISEe ER nWurww <br />$ <br />MEC E%P;Anvcnapasaro <br />$ 10.00 <br />X-1u„I,R <br />CLAIMS MADc <br />PEPSONALB ADVIN IIRV <br />$ 1,000,000 <br />_ <br />X CrDeraLAggrEgateLimii— <br />GENERALAGGREGATE <br />�Per Policy $10000000 <br />$ 2,000,006 <br />GE%E9ALAGG;RETATELIMn APP_ ES PEP <br />PROD( ACTS XIMPICPAG <br />2.000.000 <br />vRO. <br />PnLDY X ' LECT 7X uGr_ <br />_.. <br />A <br />X AUToxoslLE uaelulY <br />AL1607793 091 <br />09/01/09 COMBINED SINGLE LIMIT <br />$ 7,000,00 <br />X ANY AI<) <br />lEO ewitlenll <br />AL.nWNEDAIRs <br />BODILY INX11Y I$ <br />I <br />_ <br />� SCHEOAEC At Tny <br />1Fe1 C9r5.Jn1 <br />I <br />X HIREDAJTjc <br />DTCI v NJ[ I RY <br />$ <br />X NgN %WNE <br />rnenn <br />X Camp 51Ded <br />000 De <br />PROPERTY DAMAGE <br />X <br />F ecc4enp <br />$ <br />'X Coil 1 000 Ded <br />GARAGE LIABILITY <br />AUTO ONLY - EA ACCID-W <br />S <br />ANY AUTO <br />OTHER THAN EAACC <br />IAUTCCNLY <br />IS <br />$ <br />AGG <br />EXCESILUMBREILADABIUTY <br />BEB081872 <br />09101/08 <br />109101A19 <br />EACH OCCURRENCE <br />$ 5,000,00 <br />AGES-CATE <br />$ 5,000,00 <br />CJJMSMAGE <br />$ <br />GEDUCIBLv <br />I <br />$ <br />X RF-FNTIUN $Itz <br />A <br />WORKER cDMPENs4noN AND <br />WC4800627 (ADS) O9/Ot/08 <br />09/01/09 <br />X kwC STAnL I LITE. <br />A <br />EMPLOYERS' LIABILITY <br />WC4800628(CA) 09101/08 <br />09/Ot/09 <br />LEa�HAccICENT <br />$ 1,000.00 <br />" <br />EL DISEASE=AEMF.pYE <br />$ 1,000,00 <br />ANY PRUPRIE73R' PARTNFR.'F%FCI TINE <br />OFFJERIMEMBEREXC "Eul <br />L L.SEA.SE � �GLCV LIMIT <br />Is 1.000,000, <br />Il v% anunce unlar <br />SFF V A- PROVISI.I;NS rn,nw <br />OTHER <br />DESCRIPTION OFOPERA7IONS40CATIONSNEHICLES.EXCWSIONSADDEDRV ENDORSEMENnSP CIAL PROVISIONS <br />Re: Site 4#LA0823B/Madison Park 1528 S Standard Ave , Santa Ana, CA 92707 <br />Where required by written Contract. Certificate Holder is an Additional Insured lexoept on Workers' Comp) as respects operations of the Named Insured. <br />Where required by written contract, the above referenced pdicy(s) includes Waiver of Subrogation in favor OF the Certificate Holder. <br />CERTIFICATE HOLDER HOU-000838125-09 CANCELLATION <br />_ <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />City of Santa Ana <br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />Atln Carla Thompkins - Parks, Rec. a Community Services <br />3Q__ DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />( M-23) <br />E %ecubve Director <br />BUT FAILURE TO DO 30 WALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IEIND <br />888 W Santa Ana <br />UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />Santa Ana, CA 92702 <br />OITX. jTRES�8`EM4TAT1E 4I/ 'a3 <br />William Hines <br />ACORD25(201 4���F4�� - <br />)are(� �L <br />CtkL Jt <br />Fax from . I f L7 <br />lJ <br />0 AGVMO UUMPUNMIrVp 'WOO <br />10/16/08 07:57 Pg: 3 <br />