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<br /> <br /> <br /> <br /> ALLIANT <br /> License Number: OC36861 <br /> Phone (949) 756-0271 / Fax (949) 756-2713 N-2010-068 <br /> Certificate Number: 14 Date: 08/10/2010 <br /> VENDOR / CONTRACTOR LIABILITY PROGRAM <br /> Named Insured: SANDRA PENA SARMIENTO <br /> Address: 910 E. GRANT STREET <br /> City/State/Zip: SANTA ANA, CA 92701 <br /> Additional Insured: CITY OF SANTA ANA <br /> Contract Term: From: 08/04/10 to 12/31/1 O <br /> Description of Contract: SERVE AS DIRECTOR/PR SERVICES FOR 1 sT ANNUAL FILM FIESTA <br /> Contract Amount: $6,000.00 <br /> COMMERCIAL GENERAL LIABILITY - NEW OCCURRENCE FORM <br /> General Aggregate: $1,000,000. <br /> Products/Completed Operations Limit: $1,000,000. <br /> Personal Advertising: $1,000,000. <br /> Each Occurrence: $1,000,000. <br /> Fire Damage: $ 50,000. <br /> Medical Payments: $ 5,000. <br /> IMPORTANT! <br /> Coverages are Limited to described contract. <br /> DEDUCTIBLE: $1,000. Each Claim, Including Legal and Adjustment Expenses <br /> ANNUAL PREMIUM: $ 650.00 Fully Earned at Inception <br /> SURPLUS LINES TAX: $ 20.96 Fully Earned at Inception <br /> POLICY FEE: $ 60.00 Fully Earned at Inception <br /> TOTAL $ 730.96 TOTAL <br /> COMPANY: CATLIN SPECIALTY INSURANCE COMPANY <br /> THIS COMPANY BINDS THE KIND(S) OF INSURANCE STIPULATED HEREON. THIS <br /> INSURANCE IS SUBJECT TO THE TERMS, CONDITIONS, AND LIMITATIONS OF THE POLICY <br /> OF MASTER POLICY # 0400302958 ISSUED TO VENDORS/CONTRACTORS LIABLITY GROUP. <br /> A COPY OF THIS POLICY IS AVAILABLE ON REQUEST. <br /> THIS CERTIFICATE MAY BE CANCELLED BY THE INSURED BY SURRENDER OF THIS BINDER OR BY WRIT"T"EN <br /> NOTICE TO THE COMPANY STATING WHEN CANCELLATION WILL BE EFFECTIVE. THIS CERTIFICATE MAY BE <br /> CANCELLED BY THE COMPANY BY NOTICE TO THE INSURED IN ACCORDANCE WITH THE POLICY CONDITIONS. <br /> AUTHORIZED SIGNATURE/CO TERSIGNATURE <br /> R.E. CHAIX & ASSOCIATES INSURANCE BROKERS,INC. <br /> License Number: 0726213 _ <br /> 41 Corporate Park, Suite 310, Irvine, CA 92606 <br /> PHONE (949)722-4177 / FAX: (949)722-4172 <br /> APPROVE FORM <br /> JOSEPH W. <br /> "ITv ATTOR <br />