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,a� ®® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY 1/16/2014 ' 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 CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SPIB Insurance Agency, Inc. License Number 0719264 CONTACT AyAlherding PHONE (949) 860-3821 A/C No: (949)860-3893 60A s. eery@spib.com INSURERS AFFORDING COVERAGE NAIC9 26441 Crown Valley Parkway#200 INSURER A:Peerless Insurance Cc 24198 Mission Viejo CA 92691 INSURED INSURERe:The Netherlands Insurance Co 24171 INSURERc:Golden Eagle Ins Corporation 10836 Rue Vac Property Services Inc INSURERD:State Comp Insurance Fund 210 600 W. Taft Avenue �+�/ 1 Orange CA 92865 10 y �//9-� INSURER E: URER F: COVERAGES CERTIFICATE NUMBER: MSTR2014-15 L-A-U-P-WC REVISION NUMBER: 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 CF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INGR R TYPE OF INSURANCE DDL BUWD BR POLICY NU MBER MMIDDIEFF YYYY MMIDDIVYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR SP9558563 2/1/2019 /l/2015 DAMAGE TO RENTED PREMISES Ea occurence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL &ACV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS. COMP/OP AGO $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED tSINGLE LIMIT 1 000 000 BODI LY I NJURY(Per person) $ B X ANY AUTO ALL OWN ED SCHEDULED AUTOS AUTOS A9797086 2/1/2014 /1/2015 BODI LY I NJURY(per ads dent) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Peraccidant $ $ X COMP -PER SON X COLL PER SCH UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 L. X EXCESS LIAR CLAIMS MADE DED RETENTION$ $ ICU9558863 2/1/2014 2/1/2015 D WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNETEXECUTIVE X WC STATU- OEH- E.L. EACH ACCIDENT $ 1 000,000 OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA 9038319-14 1/1/2014 1/1/2015 E.L, DISEASE- EA EMPLOYE $ INCLUDED If yes, deeorlbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ INCLUDED A PROPERTY -SPECIAL FORM CBP9558563 /1/2014 2/1/2015 BUILDING 1,248,480 REPL COST $ 1000 DED BUSINESS PENS PROPERTY 104,040 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ^ RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA. THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM CG2010 07/04 AND CG2037 07/04, PER WRITEN CONTRACT PRIMARY AND NON-CONTRIBUTORY WORDING IS PROVIDED IN FORM # 22-111 01/07. CERTIFICATE HOLDERvolM CANCELLATION /A,x 1A�F`I"orr 5 aata-ana. orgy o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE CITY OF SANTA ANA y ACCORDANCE WITH THE POLICY PROVISIONS. 20 CIVIC CENTER-^P ' uTa Stitt She AUTHORIZED REPRESENTATIVE 01.9 �8t bVJECV. SANTA ANA, CA 927(ASS SS1Skaot L Hines, CPCU ARM CLU ACORD 25 (2010105) INS025 (201n05).01 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD