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<br />ACOR6r CERTIFICATE OF LIABILITY INSURANCE
<br />lll%.? DATE(MMIDD/YYYY)
<br />1/31/2013
<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 CONTACT
<br />NAME: Er1Ca Hornada
<br />y
<br />The Empire Company _
<br />rte/
<br />I PHONE (714) 836-9945 F N ; (714)836-9946 A/C
<br />/
<br />lJ
<br />550 Parkcenter Drive 'V E-MAIL ADDRESS: ehornaday@eaaPire-co.com
<br />Suite 205
<br />INSURERS AFFORDING COVERAGE
<br />NAIC 0
<br />Santa Ana CA 92705-3521 INSURERA:Sentinel Insurance Company, LTD 11000
<br />INSURED INSURER B :Hartford Fire Insurance Company 19682
<br />Rosenow Spevacek Group, Inc. INSURERCNational Union Fire Ins. Co.
<br />309 W. Fourth Street INSURER D:
<br /> INSURER E :
<br />Santa Ana CA 92701 INSURER F:
<br />COVERAGES CERTIFICATE NUMBER:2012/2013 Master 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 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR TYPE OF INSURANCE ADDL SUBR
<br />POLICY NUMBER POLICY EFF
<br />MM/DDIYYYY POLICY EXP
<br />MMIDD/YYYY
<br />LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY
<br />
<br />_ DAMAGE TO RENTED
<br />PREMISES Ea occurrence)
<br />$ 300,000
<br />A CLAIMS-MADE Fx
<br />]OCCUR 72SBAAH6040 /1/2012 /1/2013 MED EXP (Any one person) $ 10 , 000
<br /> PERSONAL & ADV INJURY $ 1,000,000
<br />
<br /> GENERAL AGGREGATE $ 2,000,000
<br />
<br /> GEN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS - COMP/OP AGG $ 2,000,000
<br /> X POLICY 7.]FCT 7] PRO LOC $
<br /> AUT OMOBILE LIABILITY Oa accident) LIMIT
<br />E
<br />1
<br />000
<br />000
<br /> ,
<br />,
<br />
<br />A ANY AUTO BODILY INJURY (Per person) $
<br /> ALL OWNED
<br />AUTOS SCHEDULED
<br />AUTOS 72SBAAH6040 /1/2012 /1/2013 BODILY INJURY (Per accident) $
<br />
<br />X
<br />HIRED AUTOS
<br />Ix NON
<br />-OWNED
<br />AUTOS PROPERTY DAMAGE
<br />
<br />Per accident
<br />$
<br />
<br />
<br /> X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000
<br />A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000
<br /> DED X RETENTION 10,00 72SBAA-H6040 /1/2012 /1/2013 $
<br />B WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY X WC STATU- OTH-
<br /> Y I N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EX
<br />L
<br />DED?
<br />
<br />N/A
<br />E.L. EACH ACCIDENT
<br />$ 1 000 000
<br /> C
<br />U
<br />(Mandatory in NH) 72WECEQ9740 /1/2012 /1/2013 E.L. DISEASE - EA EMPLOYE $ 1,000,000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />C Errors & Omissions 01-589-00-38 /1/2012 /1/2013 Eeach Occurrence/Aggregate 2,000,000
<br /> Claims Made; Retro 3/1/95 Deductible 10,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />City of Santa Ana as Successor Agency to the former Community Redevelopment Agency, The City of Santa
<br />Ana, the Housing Authority of the City of Santa Ana, and their officers, employees, agents and vodQlteers
<br />??
<br />are named as Additional Insured with primary and non-contributory wording with respect to t3 10mee
<br />r
<br />liability per forms IH12001185T & SS00080405 attached as required by written contract.
<br />
<br />R e`1
<br />CERTIFICATE HOLDER CANCELLATION Y'' t A lni't . -1 ' . NNW'
<br />(714)647-6549 SHOULD ANY OF THE ABOVE DES DPOLll' ANCELLED BEFORE
<br /> THE EXPIRATION DATE THE OF, NO1E WILL BE DELIVERED IN
<br />City of Santa Ana as Successor Agency to ACCORDANCE WITH THE POLICY PROVISIONS.
<br />the former Communit
<br />Redevelo
<br />ment A
<br />enc
<br />y
<br />p
<br />g
<br />y
<br />20 Civic Center Plaza M-25 AUTHORIZED REPRESENTATIVE
<br />Santa Ana, CA 92702
<br />
<br />Larry Jones/ERICA v
<br />ACORD 25 (2010/05)
<br />INS025 oninn5i m
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />Tho Ar ewn nnmo and Innn arc rcnic4crcrl marls of Arr1Rll
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