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<br />CERTIFICATE OF LIABILITY INSURANCE DATE(M(A/D0/YYYY)
<br /> 01/23/2013
<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 />NA --
<br />Levine Insurance Group LLC (=NNn.xq 860 739-4444 FAX _ni"(860? 739-6861
<br />221 Boston Post Road E-MAIL
<br />
<br />Box 339
<br />P
<br />O INSURER(S) AFFORDING COVERAGE NAtC X __
<br />.
<br />.
<br />East Lime CT 06333 INSURER A: Travelers Pro a Casual Co of America
<br />INSURED INSURER B
<br />
<br />S
<br />Saws
<br />U INSURER C :
<br />.
<br />.
<br />11 High Street INSURER D :
<br />
<br /> INSURER E : - - ----
<br />
<br />Suffield CT 06078 INSURER F :
<br />nr/r_rnn-re .urneoeo. RFVISICIN NIIMRFR,
<br />v 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 CONTRACTOR 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 />_
<br />INSR
<br />T ?
<br />?_._..._.-
<br />TYPE OF INSURANCE ADDL SUER POLICY NUMBER IMMJDDfYYYY1 POUCYEFF POLICY LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE S1,000,000
<br />
<br />A
<br />X
<br />COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
<br />Ep,11SFC (Fa "r,... en"
<br />$ 300,000 _
<br /> MADE FX I OCCUR 1-680-6A854269-TIL-12 11/17/12 11/17113 MEDEXP Anyone person) 55,000
<br /> CLAIMS- PERSONAL 8 ADV INJURY S1,000,000
<br /> GENERAL AGGREGATE $2,000,000
<br /> APPLIES PER
<br />' PRODUCTS - COMPIOP AGO s2,000,000
<br /> L AGGRE
<br />GEN :
<br />GATE LIMIT
<br /> POLICY PRO- LOC S
<br /> COMBINED SINGLE LIMIT
<br /> AUTOMOBILE LIABILITY c ' ent) .11
<br /> BODILY INJURY (Per person) S
<br /> ANY AUTO
<br /> ALL OWNED SCHEDULED 80DILY INJURY (Per accident) $
<br /> AUTOS
<br />
<br />IRED AUTOS NAUTOS
<br />ON-OWNED
<br />PROPERTY DAMAGE
<br />r-a
<br />$
<br /> H AUTOS i s
<br /> X UMBRELLA LIAR X U EACH OCCURRENCE $ 2,000,000
<br />A EXCESS LIAR M OCC
<br />R
<br />CLAIMS
<br />MADE CUP-6A854128-12-42 11/17112 11117/13 AGGREGATE $ 2,000,000
<br /> -
<br /> DED X RETENTION 0 $
<br /> WORKERS COMPENSATION WC??STLIATU- X OTH-
<br /> AND EMPLOYERS' LIABILITY
<br />JY PROPRIETOR/PARTNER/EXECUTIV YIN
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />A AI
<br />MEMBEREXCLUDED?
<br />F
<br />R N/A IJUB-3794T36-1-12 11/17112 11117/13
<br /> /
<br />OP
<br />ICE
<br />NH
<br />d
<br />i E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br /> )
<br />atory
<br />n
<br />(Man
<br />If yes, tlescribe under
<br />OESCftIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$ ,000,000
<br />
<br />DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) 0.? T ED ?.7 f
<br />P V USA
<br />The City of Santa Ana, iYs officers, employees, agents, and representatives are named as addit &
<br />insureds as per attached form CG D2 47 08 05
<br />6
<br />?
<br />ISA E. RCK
<br />ey
<br />L
<br />Assistatlt CM Attor?
<br />
<br />C;tK I IFII;A I t MULUCK 1-1
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana, CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE f `'I
<br />,C,u t ,,6j j,(C.LL,
<br />1J-1500-LV IV Ht,VRU VVRr v,?r?„v,?. yy,, ,,yi?„?ac,rc...
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />Exhibit C
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