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ACORO� CERTIFICATE OF LIABILITY INSURANCEF�ATE(MMDDIYYYY)
<br />�--'
<br />613t2011
<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 Venbrook Insurance Services CA Lic OD80832
<br />6320 Canoga Avenue, 12th Floor
<br />Woodland Hills, CA 91367
<br />www.venbrook.com
<br />CONTACT NAME: Kerrie Guenther
<br />PHONE LAIC, No E)M: 818.598.8900 FAX WC No): 818.598.891 O
<br />EMAIL ADDRESS: kguentherwenbrook. can
<br />INSURER(S) AFFORDING COVERAGE �NAIC*
<br />INSURERA : Hartford Casualty Insurance Co 29424
<br />INSURED Overland Pacific & Cutler Inc.
<br />3750 Schaufele Avenue, Suite 150
<br />Long Beach CA 90808
<br />INSURERB : Hartford Fire Insurance Company 19682
<br />INSURER C: Tudor Insurance Company 37982
<br />INSURER D
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER: 10333527 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. NO-rWITHSTANDINGANY 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 />EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />TR
<br />TYPE OF INSURANCE
<br />ADDL
<br />POLICY NUMBER
<br />MM IDEFF
<br />LCY EXP
<br />MMILDI
<br />DfYYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />�/
<br />72UUNTR7859
<br />6/12011
<br />6/12012
<br />EACH OCCURRENCE $ 1,000,000
<br />COMGE
<br />MERCIAL GENERAL LIABILITY
<br />TO RENTED
<br />PREMISES (Ea occurrence ) $ 300,000
<br />CLAIMS -MADE 1z OCCUR
<br />MED EXP (Any one person) $ 10,000
<br />PERSONAL&ADV INJURY $ 1,000,000
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 2,000,000
<br />POLICY PRO- LOC
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />72UUNTR7859
<br />6/12011
<br />6/12012
<br />COMBINED SINGLE LIMIT
<br />(Ea accident $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />BODILY INJURY (Per accident) $
<br />PROPERTY DAMAGE
<br />Peraccrdent} $
<br />V/
<br />NON-OVINED
<br />HIREDAUTOS V/ AUTOS
<br />$
<br />,/
<br />Comp Ded $1,000
<br />$
<br />V
<br />Coll bed $1,000
<br />A
<br />✓
<br />UMBRELLA LIAB OCCUR
<br />72RHUTR7849
<br />6/12011
<br />6/12012
<br />EACH OCCURRENCE $ 2,000,000
<br />AGGREGATE $ 2,000,000
<br />EXCESS LIAB CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBEREXCLUDED? F
<br />NIA
<br />72WETQ9133
<br />6/12011
<br />6/12012
<br />vvc sTATu- o
<br />TORY LIMITS R
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />E.L. DISEASE - EA EM PLO YEEI $ 1 00 0
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />C
<br />Professional Liab.
<br />EOP0037170
<br />6/1/2011
<br />6/12012
<br />$2,000,000 Each Claim
<br />Claims Made
<br />$2,000,000 Aggregate
<br />$50,000 Deductible
<br />DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />The City of Santa Ana, its officers, agents, employees, consultants, special counsel & representatives are named as additional insured per attached
<br />endorsement #HG00010605 (excl work comp) on primary & noncontributory basis where required by contract. Subject to policy terms, conditions,
<br />and exclusions.
<br />APPROV .i) AS F0 z'Od"M
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Ana Laura, Sl iu 5i'I %u..
<br />Public Works Agency, M-36
<br />P.O. Box 1988 Assistant� Ci(v
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92702
<br />(WH) Pamala Nash
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />CERT NC.: 10333527 Kerrie Cuentter 6/3/2011 2:33:55 PM Page 1 of 5
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