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A� °® CERTIFICATE OF LIABILITY INSURANCE
<br />1/16/2014 '
<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 the policy, 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 Ay Alherding
<br />SPIB Insurance Agency, Inc.
<br />License Number 0719264
<br />PHONE (949) 860 -3821 A/C No: (949)860 -3893
<br />60A s. eery @spib.com
<br />INSURERS AFFORDING COVERAGE
<br />NAIC9
<br />26441 Crown Valley Parkway #200
<br />INSURER A:Peerless Insurance Cc
<br />24198
<br />Mission Viejo CA 92691
<br />INSURED
<br />INSURERe:The Netherlands Insurance Co
<br />24171
<br />INSURERc:Golden Eagle Ins Corporation
<br />10836
<br />Rue Vac Property Services Inc
<br />INSURERD:State Comp Insurance Fund
<br />210
<br />600 W. Taft Avenue
<br />�+�/ 1
<br />Orange CA 92865 10 y �//9 -�
<br />INSURER E:
<br />$ 5,000
<br />URER F:
<br />$ 1,000,000
<br />COVERAGES CERTIFICATE NUMBER: MSTR2014 -15 L- A- U -P -WC REVISION NUMBER:
<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 CF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INGR
<br />R
<br />TYPE OF INSURANCE
<br />DDL
<br />BUBR
<br />WD
<br />POLICY NU MBER
<br />MMIDDIYYYY
<br />MMIDDIVYYY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />SP9558563
<br />2/1/2019
<br />/1/2015
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurence
<br />$ 100,000
<br />MED EXP(Any one person)
<br />$ 5,000
<br />PERSONAL &ACV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GENL AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS. COMP /OP AGO
<br />$ 2,000,000
<br />X POLICY PRO LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />CEOMaBBIIaEEDtSINGLE LIMIT
<br />3_000,000
<br />BODI LY I NJURY(Per person)
<br />$
<br />B
<br />X
<br />ANY AUTO
<br />ALL OWN ED SCHEDULED
<br />AUTOS AUTOS
<br />A9797086
<br />2/1/2014
<br />/1/2015
<br />BODI LY I NJURY(per ads dent)
<br />$
<br />X
<br />NON -OWNED
<br />HIRED AUTOS X AUTOS
<br />PROPERTY DAMAGE
<br />Peraccidant
<br />$
<br />$
<br />X
<br />COMP -PER SON X COLL PER SCH
<br />UMBRELLA LIAR
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />L.
<br />X
<br />EXCESS LIAR
<br />CLAIMS MADE
<br />DED RETENTION$
<br />$
<br />ICU9558863
<br />2/1/2014
<br />2/1/2015
<br />D
<br />WORKERS COMPENSATION
<br />ANDEMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETOWPARTNETEXECUTIVE
<br />X WC STATU- OEH-
<br />E.L. EACH ACCIDENT
<br />$ 1 000,000
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />(Mandatory In NH)
<br />NIA
<br />9038319 -14
<br />1/1/2014
<br />1/1/2015
<br />E.L, DISEASE- EA EMPLOYE
<br />$ INCLUDED
<br />If yes, deeorlbe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ INCLUDED
<br />A
<br />PROPERTY - SPECIAL FORM
<br />CBP9558563
<br />/1/2014
<br />2/1/2015
<br />BUILDING 1,248,480
<br />REPL COST $ 1000 DED
<br />BUSINESS PENS PROPERTY 104,040
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />^ RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E. SANTA ANA BLVD., SANTA ANA, CA.
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATIVES ARE NAMED AS
<br />ADDITIONAL INSUREDS WITH RESPECT TO GENERAL LIABILITY AS PER COMPANY FORM CG2010 07/04 AND CG2037 07/04,
<br />PER WRITEN CONTRACT PRIMARY AND NON - CONTRIBUTORY WORDING IS PROVIDED IN FORM # 22 -111 01/07.
<br />CERTIFICATE HOLDER volM CANCELLATION
<br />/A,x 1A�F`I"or 5 data -ana. orgy o
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />THE CITY OF SANTA ANA
<br />y
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 CIVIC CENTER -^P ' uTa Stitt She
<br />AUTHORIZED REPRESENTATIVE
<br />SANTA ANA, CA 92701- iit 01.9 �8t bVJECV.
<br />L Hines, CPCU ARM CLU
<br />ACORD 25 (2010105)
<br />INS025 (20m05).01
<br />©1988 -2010 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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