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<br />19 CERTIFICATE OF LIABILITY INSURANCE OPID GEND <br />1D D4 tt <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 INSURENS),AUTHORI2ED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />1 ecoA cafe o ens an y sl en read, Left <br />the terms and conditions 0he Policy, ceAaln )DICES 'ayrep,!manendememeRL Astatement on this cerdficamdoes not confer 6i hbtothe <br />cedlRcadeholder In lieu of such endomamenti <br />PRODUCER <br />I <br />Pete[ C <br />Pa <br />S Ass <br />i <br />t <br />r' <br />. <br />y <br />a <br />oc <br />es <br />CA License N0803080 luolwl', <br />21650 Oxnard 9t., Suite 1900 ADDRESS <br />Woodland Hills CA 91361 CPRI <br />Ptona,818-703.8057 Faz:81S-703-0935 <br /> IxsuwENalarECgomccrnEau E NaoR <br /> <br />Richards, Watson S Gershon <br />355 9 <br />Grand Ave 40th Flo Imuwswa: Federal Insurance Com an 20281 <br />. <br />Los Angeles CA 9b071-3101 INSURER c: <br />N'20?j • ? 03 IreuaEIRD: <br /> ImURFAF, <br /> <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERI THAT TNE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AIM FOR THE POLICY PERIOD <br />INDICATED NOTATHSTANDING ANY REO°IREYENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MTN RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR BY PERTAIN, WE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLGSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR TYPE OF INSURANCE MIT PmICYNUMe N @ TV Y INNNMYIYI LNIiS <br /> GENERAL LIABILITY EPCHOCWRRENCE <br />EACHOCCUR ENCE 81,ODD,OOO <br />A zi ENE Rw <br />, <br />Ln 35293250 rB/BL/11 Lc/01/12 <br /> T <br />0 <br />c <br />MaDE OCCUR NEDEXPWA me Teem) 810,000 <br /> % PERSONAL aADVINJURY 31,0001000 <br /> <br /> GENERALAGGREGATE 82100000 <br /> GENLAGCRECATE[IMGAPPpEB PER. PROOUCISCOIWroPAW SINCLOOED <br /> Poutr ii° X Loo Em Sen. L1 000 000 <br /> au rosaBlLLwaum ODnaINEOSINGLEUUn <br />N <br />31 <br />a9o <br />DD0 <br />S AInAUTa 74967929 ?a? <br />B?u , <br />, <br /> to/ouu rB/ouu <br /> <br />AuoWWEDwTOS aooILYlNmwvlPa?P?ol s <br /> <br /> <br />scgeouLEDAlnos <br />eomlrlNduRYIPAixuasRq -- <br />3 <br /> PPOPER7Y0.4MAGE <br /> % HuuDAUros <br />(PaultlsRp a <br /> % NoNOwrvEOAUios s <br /> 9 <br />g % uNewEluLaB X ottuR 79fi1158fi r°/ouu ro/Dole FACHOCrHRRENCE s9, 000,000 <br /> <br />FXLE9B LMB <br />CWMSMAOE <br />AGGREGATE _ <br />99,000,000 <br /> OEOGGTIBLE , y <br /> <br /> % RETEMION 9 -O- 9 <br />B NVRNEr6CONPFN3AlI0N rB/ouu rPlou[e X <br /> ANDFNPLDYFIix IIaBIIRf Y 10AYlIMRS ER <br /> IN <br />ANYPROPRIEi0PRA91NENEXECGTN <br />OFFICEPJMEMBEREXCWIXOi ? <br />rrA EL EACNACCmENi 91 OOO DOO <br />? ? <br /> eAOAAMryInNN <br />N <br />A <br />R EL DISEASEFAEMPLOYEE 31,000,000 <br /> yyd <br />BIGI <br />YfI?I <br />DEBCRIPTIONOF OPERATIPN&Aakw <br />EL OISEABEPOOCYLIMIi <br />31 000 000 <br /> <br />DESCRIPTION OFWERAIION3I LOWTIONSIVENIOLF9IAWdi ACOPDIm, AEenmA Pomd19ehPBUh,MrtmpioAanaul ?? ?? ?O ?,QRM <br />Certificate Nolder fe named ae Additional Insured as tteir intetes say <br />appear. Subject to ppolity te[ms conditions and exclueions.Covexa a is <br />d <br />+ <br />e <br />considered pramaay A non-cont[i <br />utary. <br />10 days notice of cancel <br />lation <br />applies fox non-payment of p[emiwo. <br />CERTIFICATE HOLDER CANCE0.ATION <br /> SIIOUID /NY OF THE A90YE re6C?U9E0 POLICIa9 BE CANLELLF? BEFORE <br />SANTA•2 iNEEVIRInONOAIETNEREOF,NNICEWILLBEDEWEPEDIN <br /> aCCpPDPNCE WIIX INf PoIWV PROVI9GNa <br />City of Santa Ana <br /> <br />Office of the CiTy Attorney auTNDevEDasRFSENTATNE <br />TwenTy Civic Center Plana <br /> <br /> <br /> <br />anta Ana CA 92701 USTOMER Ii RICKI <br />INSURED InsuaEwa: Chubb Insurance Company 41386 <br />INSURER F: <br />Pete[ C. Foy producer <br />®1984?2009ACOR000RPORATION. All righq reserved <br />ACOR02S ?4009148? iMAC0A0 name mtllopoare replsdred maths ofACORO