|
ACORO®I DATE (MwDDIYYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 7/5/2011
<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 INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
<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 thepolicy, 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
<br />CONTACT
<br />NAME: Trish 1:Cusa1
<br />C. M. Maiara Company, Inc_
<br />(618)224-6100 FAX (818)224-6099
<br />A/C No
<br />wlilAlL RES., L -s. com
<br />EEA
<br />21045 CaliFa St. NIDD
<br />PRODUCERCLISMOMER 00027846
<br />INSURE (S) AFFORDING COVERAGE NAIC0
<br />Woodland Hi11s CA 91367
<br />INSURED
<br />INSURERA.HM-t£o=6 Casualty Insnce, CO
<br />uraance,
<br />EACH OCCURRENCE S 1,000,000
<br />INSURER B H—t-Eoi'C1 Fire, InsurCo.
<br />LaBalla MaZ :Ln, InIa.
<br />NSIJRERC:U_S. SpaClalty Ins Co
<br />2700 So. Grand AVa
<br />INSURER
<br />NSU RER D:
<br />72SBAWLI6283
<br />6/16/2011
<br />Santa Ana CA 92705
<br />LIINSURER
<br />NSURERF:
<br />COVERAGES CERTIFICATE NUMBER -CM -116621047 REVISION NUMBER--
<br />THIS
<br />UMBER:
<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 />POLICY NUMBER
<br />IMPw or EFF
<br />MMPOLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,000
<br />PREMISES (En ocri,rtence $ 300,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE FX7 OCCUR
<br />X
<br />72SBAWLI6283
<br />6/16/2011
<br />/16/2012
<br />MED EXP An one rson) S 3.0,000
<br />PERSONAL 8 ADV INJURY $ 1,00 0'000 ,000
<br />GENERAL AGGREGATE S 2,00!0,_000
<br />GEN -L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS-COMPIOP AGG S 2,000, 000
<br />X POLIGY PRO LOC
<br />S
<br />B
<br />AUTOMOBILE LIABILITY
<br />XANY AUTO
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />X HIRED AUTOS
<br />72VECAB0364
<br />APPRU V Eij A
<br />6/16/2011
<br />TO FORM
<br />/16/2012
<br />COMBINED SINGLE LIMIT
<br />(Ea acuaent) S 1,000,000
<br />BODILY INJURY (Per Parson) $
<br />BODILY INJURY (Par accident) S
<br />PROPERTY DAMAGE $
<br />(Per xr dant)
<br />X NON -OWNED AUTOS�'�
<br />i
<br />Dht other gar S
<br />Uninsured motorist combined S 1 , 000 , 000'
<br />X UMBRELLA LIAB
<br />EXCESS LIAB
<br />X OCCUR
<br />CW MSMADE
<br />aura.
<br />�A5sislant
<br />�72..15.8.
<br />CC y
<br />Attorn O)'
<br />EACH OCCURRENCE S 5,000,000
<br />AGGREGATE S 5,000,000
<br />DEDUCTIBLE
<br />$
<br />A
<br />X RETENTION $10 000
<br />6/16/2011
<br />6/16/2012
<br />$
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY �.� N
<br />ANY PROPRIETOWPARTNEWEXECUTIVE=
<br />OFFICER/MEMBER EXCLUDED?
<br />(M.nd.lory In NN)
<br />MIA A
<br />72WECRiQ5613
<br />6/16/2011
<br />6/16/2012
<br />X ST U- OTH-
<br />FJEL CHACC 11 ENT $ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />If YYea deacflbe udder
<br />DESGrRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT S 1.000.000
<br />C
<br />Prof£ -atonal Liability
<br />991020500
<br />6/16/201.1
<br />6/16/2012
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aa ch ACORD 101, Addltbnal R—M, Schedule, K mora epee. Is raqulred)
<br />City of Santa Ana is iL—Iuded as Additional lnaured par the Business. LiabiliCy Coyarag- roan SSOOOB and a General
<br />Liability Waiver o£ Subrogation applies to the, certi£i tato hold -r par loan SSOOOS.
<br />mbootha@sante,-ana.Org
<br />City o£ Santa Ana
<br />At tn: Marilyn Boothe,
<br />20 Civic Cantor Plaza (M-36)
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Rotrs..,.s../TRISH�-aCG
<br />INSO25 (21X1 o) The ACORD name and logo are registered ma
<br />
|