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i1 Policy Number: 605503396 Date Entered: 12/7/2013 <br />'�lla R CERTIFICATE OF LIABILITY INSURANCE <br />127/20 3` <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 endofsement(s). <br />PRODUCER <br />Rodgick Insurance <br />196 Technology Drive, Suite B <br />Irvine, CA 92618 <br />NAME CONCT Poll <br />- -- <br />eHMa� .(949) 753 -9555 ac NOL(949)753 -9559 <br />ADDRESS: <br />INSUREWSI AFFORDING COVERAGE <br />NAICN <br />INSURER A: Fareers Insurance Exchange <br />21652 <br />2/07/2013 <br />_ <br />INSURED Santa Arta Business Council, Inc. <br />INSURER S: State Compareation Insurance Fund <br />35076 <br />Carlos Madriles <br />INSURER C: Travelers <br />31194 <br />INSURER O: <br />PERSONALBADV IWURY <br />400 E. 4th Street <br />Santa Ana, CA 92701 <br />INSURER E: <br />NSURERF: <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 />- -- <br />WSR <br />LM <br />TYPE OF INSURANCE <br />INAR <br />WVD <br />POLICY NUMBER <br />PODGY up- <br />IMMID <br />MMIO <br />LDaRS <br />A <br />GENERAL LIABILITY <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE X OCCUR <br />605503396 <br />2/07/2013 <br />2/07/2014 <br />EACH OCCURRENCE <br />51,000,000 <br />GESHEa oc7E� <br />PREMISES Ea oeartenra <br />S 100,000 <br />MED EX"(Airy Ora person) <br />510,000 <br />PERSONALBADV IWURY <br />S11000, OOO <br />GENERAL AGGREGATE <br />52,000,000 <br />GEHL AGGREGATE <br />LIMIT APPLIES <br />PER <br />PRODUCTS_ COMP/OP AGG <br />$1,000,000 <br />POUCYI <br />PRO- <br />JECT <br />LOC <br />I <br />S - <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />X <br />605503396 <br />2/07/2013 <br />2/07/2014 <br />Eae N Dl IN L L IT <br />A1,000,000 <br />BODILY IWURY(Perpelsan) <br />$ <br />H <br />ALL OWNED AUTOOSULEO <br />BODILY IWURY(Paracoder0) <br />S <br />NON-OWNED <br />HIRED AUTOS AUTOS <br />S <br />PRORERTYDAMAGE <br />Per adodJ <br />S <br />UMBRELLA DAB OCCUR <br />EACHOCCURRENCE <br />S <br />AGGREGATE <br />S_ <br />QCEss LINS cuists'MADE <br />DELI F RETENTION S <br />_I, <br />$ <br />B <br />1 WORNERSCOMPENSAnM <br />1 AND EMPLOYERSL YIN IABILITY <br />1 ANY PROPRIETORNARTNER/EXECLRIVE <br />1 OFRCEPoMEMBER QCLUDED? <br />(Mandatory In NH) <br />N/A <br />9081384 -13 <br />2/10/2013 <br />2/10/2014 <br />WC STATU- OTH- <br />TORY LIMITS ek <br />E.L. FACH ACCIDENT , <br />S 1,000,000 <br />_ <br />E.L. DISEASE - EA EMPLOYEE <br />S 1, OOO , OOO <br />Dyes. RsTI ON Omer <br />DESCRIPTION OF OPERATIONS below <br />E.L. DI B CV LIMB <br />E 1, 000,000 <br />C <br />Fidelity Bond <br />106032811 <br />2/07/2013 <br />2/07/2014 <br />5,0 500,000 <br />C <br />060 <br />106032811 <br />z /o7 /zo13 <br />z/o7/2014 <br />SIR 1,000,000 <br />C <br />EPL <br />106032811 <br />2/07/2013 <br />2/07/2 <br />, SZ 1,000,000 <br />DESCRIPRON OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD IN. A4 fitional Remoras Schedule, If more space Is <br />ell <br />Q� <br />The City of Santa Ana, its officers, agents and employees are n om <br />�os�s <br />a t�6SMnal insureds for General <br />Liability purposes. <br />!O( <br />e <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92702 <br />Attn: Risk Management - Briza Morales <br />AUTHORIZED REPRESENTATIVE <br />©1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />Produced using FoAns Boss Plus soflwm w FennsBoss.com: Impressive Publishing 8W- 208.1477 <br />