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. a OP ID: PC
<br />, CERTIFIG,,TE OF LIABILITY INSURL.NCE 1
<br />DATE (MMIDDNYYY)
<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 626 -405 -8031 N
<br />CONACT
<br />AIC NO Ext : FAX
<br />PHONE
<br />COVERAGES (aK I IFwA I C NUIVIO =rc: - -- - -- - -
<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 />A111K 9U`BR POLICY EFF POLICY EXP LIMITS
<br />INSR
<br />LTR TYPE OF INSURANCE POLICY NUMBER MM /DDNYYY MMIDDNYYY
<br />CUR CE $ 1,000,000
<br />TOT
<br />GENERAL LIABILITY FJ+CH OCREN
<br />A X COMMERCIAL GENERAL LIABILITY X RIC0012016 10/01/11 10!01112 PREMISES Ea occurrence $ 100,000
<br />CLAIMS -MADE � OCCUR MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />X Professional Liab
<br />AL AGGREGATE $ 3,000,000
<br />X Sexual Abuse Liab GENER
<br />GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 3,000,000
<br />Prof Liab $ 1 mil /3mil
<br />POLICY JEC LOC
<br />A - COMBINED SINGLE LIMIT
<br />AUTOMOBILE LIABILITY $
<br />(Ea accident)
<br />ANY AUTO BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS BODILY INJURY (Per accident) $
<br />SCHEDULEDAUTOS PROPERTY DAMAGE $
<br />(Per accident)
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00
<br />X EXCESS LIAR CLAIMS -MADE 10/01/11 10/01/12 AGGREGATE $ 2,000,000
<br />LA REL0012017 $
<br />DEDUCTIBLE
<br />X RETENTION $ $
<br />WORKERS COMPENSATION WC STATU- OTH-
<br />X TORY IMITS X I ER
<br />AND EMPLOYERS' LIABILITY 02101/11 02/01/12 E.L. EACH ACCIDENT $ 1,000,000
<br />B ANY PROPRIETOR /PARTNER /EXECUTIVEY NI 6600000287111
<br />OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />(Mandatory in NH) 1,000,000
<br />If yes, describe under E.L. DISEASE - POLICY LIMIT $
<br />DESCRIPTION OF OPERATIONS below 425,000
<br />A Property Coverage RIC0012016 10/01/11 10/01/12 Blkt Cont
<br />A Crime Coverage I IRICOO12016 10101/11 10/01/12 Empl Dish 200,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: Contract #A- 2010 - 061 -002; A- 2009 -133; A- 2009 -133A. City of Santa Ana,
<br />its officers, employees, agents, volunteers and representatives are named
<br />additional insured with respect to the General Liability policy of the named
<br />insured per the attached CG 2026 endorsement. Such insurance Is primary and
<br />non-contributory per the attached endorsement. Workers Compensation Contd.
<br />CERTIFICATE HOLDER uANGELLAT ION
<br />CITY016
<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. .O�
<br />City of Santa Ana
<br />Community Dev. Agency (M -25) AUTHORIZED REPRESENTATIVE
<br />20 C Frank Hernandez ID �+
<br />20 Civic Center Plaza, M -25 (\, -ynl' O'�j'�+
<br />Santa Ana CA 92701
<br />©1988 -2009 ACO RPORATION
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />PssS�a�
<br />G\rCy r-
<br />CERTIFICATE HOLDER uANGELLAT ION
<br />CITY016
<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. .O�
<br />City of Santa Ana
<br />Community Dev. Agency (M -25) AUTHORIZED REPRESENTATIVE
<br />20 C Frank Hernandez ID �+
<br />20 Civic Center Plaza, M -25 (\, -ynl' O'�j'�+
<br />Santa Ana CA 92701
<br />©1988 -2009 ACO RPORATION
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />PssS�a�
<br />G\rCy r-
<br />
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