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<br />A CERTIFICATE OF LIABILITY INSURANCE
<br />D`T2212012
<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 />If the holder is an ADDITIONAL INSURED, the pol cy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />IMPORTANT: certificate
<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 endorsemerrt(s).
<br />PRODUCER Phone: 0,10A78-5041
<br />Fax: (310)479 -8707
<br />NI.G. Skinner & Associates
<br />1 1030 Scrota Monica Blvd.
<br />TACT
<br />PHONE FAX
<br />I:
<br />EMAIL
<br />ADDRESS: .....-
<br />_ -_ —'-
<br />INSURERS) AFFORDING COVERAGE _ .............. __...5-
<br />`
<br />NAIC It
<br />Suite 207
<br />__
<br />INSURERA: National Union Fire Insurance Company Of Pittsburgh, 1 111
<br />19445
<br />Los Angeles, California 9125
<br />INSURED
<br />INSURER B : Federal Insurance Company _.._-
<br />20281
<br />INSURER C : ACC American Insurance COinpany
<br />22667
<br />The .Act I Group, Inc., dba: ATIMS
<br />INSURER D : UndeI'Ftiriters At Lloyd`S, London _
<br />15792
<br />P.O. Box 29048
<br />Glendale, CA 91X)9 -9048
<br />__....._...._..
<br />INSURER E
<br />PERSONAL & ADV INJURY
<br />INSURER F
<br />icn.�cat rCDTlClf -eT - MiI MBER• ATIMSnf, -I REVISION NUME3EK:
<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
<br />ADO
<br />._BHT
<br />_......._ POLICY EFF POLICY EXP LIMITS
<br />POLICY NUMBER MWDD MM/DOIYY
<br />'GENERAL LIABILITY
<br />Santa Ana, CA 92701
<br />SSL 4257556 14,i 11201 l i 411 /2012 EACH OCCURRENCE _.. - --
<br />TO RENT—ED
<br />$ 3- ,(0(A.) 000
<br />$ 1 00,01)0
<br />COMMERCIAL GENERAL LIABILITY
<br />i j PREMISES Ea owxrence
<br />$_ 5,00()
<br />A
<br />CLAIMS -MADE OCCUR
<br />MED EXP (Any one Person)
<br />_._..
<br />$ 3,009 ,00O
<br />---.—
<br />'~
<br />PERSONAL & ADV INJURY
<br />$ 3.000,000
<br />GENERAL AGGREGATE.._.__... J
<br />j PRODUCTS - COMP/OP AGG
<br />GEML AGGREGATE LIMIT APPLIES PER:
<br />$ 3,01}0,0 04
<br />���-
<br />$
<br />PR0.
<br />POLICY r— LOC
<br />AUTOMOBILE LIABILITY
<br />.COMBINED SINGLE LIMIT
<br />7318- 3'7-62 j 4f 1 '20 11 411/2012 €a ,I
<br />1 -(7� �C
<br />_...... --
<br />B .. ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />$
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident)
<br />— AUTOS AUTOS
<br />( NON -OWNED
<br />PROPERTY DAMAGE
<br />$
<br />j- ✓ ';. HIRED AUTOS AUTOS
<br />',...(Per accident
<br />._.......
<br />$
<br />I UMBRELLA LIAB
<br />r/
<br />OCCUR
<br />024591348 1 4/1'2011 i 4111/2012 EACH OCCURRENCE
<br />$ 1O.000,0O0
<br />5 I O,(N30,()(l0
<br />-- ..._........ — (H)O,
<br />- EXCESS LIAB
<br />CLAIMS-MADE
<br />j AGGREGATE _
<br />+' DED ✓ RETENT
<br />$
<br />WORKERS COMPENSATION
<br />C_
<br />W1,RC431 1961;6 4I1 /2011 112(} 12 WC 3TATU- OTH-
<br />---
<br />$ 1,000,000
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNERIEXECLMVE —]
<br />E.L. EACH ACCIDENT
<br />1,000,000
<br />$ _
<br />OEFICERA4EMBER EXCLUDED?
<br />(Maoaamry in NH)
<br />NIA
<br />E.L. DISEASE - EA EMPLOYE
<br />-- --- - - - - --
<br />$ 1 ,0(N),(H)0
<br />If yes, desaibe w,der
<br />DESCRIPTION OF OPERATIONS tebw
<br />E.L DISEASE -POLICY LIMIT
<br />D Errvrs muslons
<br />(
<br />F_
<br />817(2011 8/7/2012 l,0(:8),0O0
<br />C,ec�.urncs
<br />0039 OJ
<br />AP Q ?,000,000
<br />3uvrev3te
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H mom space Is required)
<br />city of Santa Ana, its officers, employees, agents, volunteers and representatives are add,-tiona'l insureds under the
<br />General Liability policy. Primary and Non Contributory coverage clause will apply. Separation: of Insureds clause
<br />applies under the General Liability policy. Notice cf Cancellation under General Liability: 30 days i 10 days for
<br />non- pa�^¢ent of premium or fraud.
<br />CERTIFICATE HOLDER u"_ -f�� _ —17 - . / CANCELLATION
<br />EIk Ilier's Nature nt' liiterest : Additional InsIlred - edy
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />Ci of Santa Ana ; G' °. ? i i i A t t c; f r1
<br />r}' y
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />, ACCORDANCE WITH THE POLICY PROVISIONS.
<br />20 Civic Center Plaza
<br />AUTHORUM REPRESENTATIVE
<br />Santa Ana, CA 92701
<br />01988 -2010 ACORD CORPORATION. AI rl�fts reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
<br />
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