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OP ID: 19
<br />140c"RO CERTIFICATE OF LIABILITY INSURANCE
<br />DAT 12 /11D/YYYY)
<br />12/11/12
<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 650 - 393 -2000
<br />San Francisco P &C 650- 393 -2001
<br />Hays of California Ins Service
<br />1350 Ba shore Hwy, 218
<br />Y
<br />Burlingame, CA 9400 10
<br />Kathv
<br />NAME: CONTACT
<br />PHONE Fax 1AfC (A/C. No
<br />E -MAIL
<br />ADDRESS:
<br />PRODUCER I ICLEI -2
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURED ICLEI USA Inc
<br />Monica Gilchrist
<br />414 13th Avenue, Suite 400
<br />Oakland, CA 94607
<br />/'y `
<br />INSURER A: Hartford Fire Insurance Co.
<br />19682
<br />INSURER B: Federal Insurance Company
<br />20281
<br />INSURER c: National Union Fire Ins. Co.
<br />19445
<br />INSURER D:
<br />EACH OCCURRENCE
<br />INSURER E:
<br />PREMISES Ea occurrence
<br />INSURER F
<br />B
<br />COVERAGES CERTIFICATE NUMBER: 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 />TR
<br />TYPEOFINSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />POLICY EXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,0
<br />PREMISES Ea occurrence
<br />S 1,000,00
<br />B
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I OCCUR
<br />X
<br />X
<br />35893974
<br />11/26/12
<br />11/26/13
<br />MED EXP (Anyone person)
<br />S 10,00
<br />PERSONAL & ADV INJURY
<br />$ 1,000,00
<br />GENERALAGGREGATE
<br />$ 2,000,OU
<br />GE N'L AGGREGATE LIMIT APPLIES PER
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,00
<br />X I POLICY PRO- LOC
<br />$
<br />B
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />ALL OWNED AUTOS
<br />X
<br />73549972
<br />11126/12
<br />11/26/13
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,00
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />S
<br />X
<br />X
<br />$
<br />NON -OWNED AUTOS
<br />$
<br />NO OWNED AUTOS
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />S 2,000,00
<br />AGGREGATE
<br />S 2,000,00
<br />B
<br />ESS LIAB
<br />CLAIMS -MADE
<br />X
<br />7983 -82 -51
<br />11/26/12
<br />11!26113
<br />UCTIBL E
<br />IDE
<br />S
<br />$
<br />ENTION $
<br />A
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOR /PARTNER/EXECUTIVE
<br />OFFICER /MEMBER EXCLUDED? FNI
<br />NIA
<br />57WECLX9368
<br />11/01/12
<br />11/01113
<br />X WC STATU- OTH-
<br />TORY LIMITS ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,00
<br />E.L. DISEASE - EA EMPLOYE
<br />S 1,000,00
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />S 1,000,00
<br />C
<br />Errors & Omissions
<br />01 -423 -70 -01
<br />11/26/12
<br />11/26/13
<br />E & O 1,000,00
<br />Ded. 10,00
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are named as additional insured with regard to the liability
<br />and defense of suits arising from the operations and uses performed by or
<br />or or on behalf of the named insured. Notice of cancellation for
<br />M
<br />CERTIFICATE HOLDER rANCFI I ATION
<br />ACORD 25 (2009/09)
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />City of Santa Anna et al)
<br />{See below) S`
<br />a
<br />Attn: Christy Kindig
<br />P. O. Box 1988, M -21 .A,sSistant City Attorney
<br />Santa Ana, CA 92702
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2009/09)
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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