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.4coRO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1O/6?2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CO?T??? ? r.,r0I??2A?T $?TWEEN THE ISSUING INSURER(S), AUTHORIZED '' REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HO ?J YI I 1.? IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) mast be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may re?ii?a?I er}dorsement.- -,A _`-t?rpent on this certificate does not confer rights to the _ certificate holder in lieu of such endorsement(s). \ H 7 N PRODUCER N ?IEncr, cTe yola Ames and Gough ^y ? I O '- O I PHONE tL (770) $$2-4225 ??-?? (A/C. Nol- N ? O? O 450 Northridge Parkway -MAIL ADDRESS:7n?Yo1a@amesgough. com $ulte 102 PRODUCER 00001396 Atlanta GA 3O3SO INSURER 5 AFFORDING COVERAGE NAIC # INSURED INSURERA:Trayelers Indemnl ty CO Of CT INSURER B :T raVelar9 lndemni tv Compan Kimley-Horn and Associates, Snc. INS_URERC Travelers Property Cas ualt?+ _Co. P.O. Box 33068 INSURERD:Phoenix 2nsurance Company INSURER E Travelers Pr ? _Cas Co America Raleigh NC 27636 wsuRERF: COVERAGES CERTIFICATE NUMBER30-11 (Kimlev Jessica) RFF/i4Yr]N NI IMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IN SU BR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 X COMMERCIAL GENERAL LIABILITY DAMA? RENTED PREMISES Ea occurrence 1 , 000 , 000 $ A CLAIMS-MADE ? OCCUR 630-315X3976-TCT-10 9/1/2010 9/1/2011 MED EXP (Any one person) _ $ 10 , 000 PERSONAL 8 ADV INJURY $ 1 , 000 , 000 GENERAL AGGREGATE $ 2 , 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 1 , 000 , 000 POLICY X PROT X LOC $ AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000 , 000 X (Ea accident) B ANY AUTO 810-171 L6115-I -10 9/1/2010 9/1/2011 BODILY INJURY (Per person) S ALL OWNED AUTOS - BODILY INJURY (Per accitlen[) --- $ SCHEDULED AUTOS asc R -L? T aO F? hi AMAGE O - X HIRED AUTOS Per a citlont? $ X NON-OWNED AUTOS Untlerinsuretl motorist BI split S Uninsuretl motorist property $ X UMBRELLA LIAB X OCCUR ,? t O EACH OCCURRENCE $ 5 , 000 , 000 EXCESS LIAB CLAIMS-MADE a? ¦ ? AGGREGATE $ 5 , 000 , 000 DEDUCTIBLE v0? C A?Ot7sC g C X RETENTION $ 10 000 P-171L6115-TIL O 1/2010 9/1/2011 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C-B36GB783-10 9/1/2010 9/1/2011 X WC BTATU- OTH- Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFI ER/MEM N? N/A E-L- EACH ACCIDENT $ 500 000 $ C BER EXCLUDED? (Mantlatory In NH) C-836GB7 B3-10 (CA) 9/1/2010 9/1/2011 EL DISEASE - EA EMPLOYE $ $00 000 It yes, tlescnbe under - DESCRIPTION OF OPERATIONS below E-L. DISEASE -POLICY LIMIT S $QQ Q00 DESCRIPTON OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD '10'1, Atltll[lonal Remarfts Schetlule, h more space Is required) Re: McFadden McDOnalds. The City o£ Santa Ana, its officers, employees 6 volunteers era named as Additional Insureds on the above referenced liability policies with the exception o£ workers compensation 6 professional liability. Umbrella Follows Form. City o£ Santa Ana Planning Division P.O. Box 1988 M-20 Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATVE Ormaza/JOSH © 1988-2009 ACORD CORPORATION. All rights reserved. INaUZ? (200909) I ne AIiVKV name ana IOgO are r@9151e re0 marK3 OT AIiVKU