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CERTIFICATE OF LIABILITY INSURANCE I DATE 9/t18/2013 Y'
<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 />NAME: ghavna Chauhan
<br />Marsh USA Inc. PH t (212) 345 -8735 FA NO: (212) 948 -8852
<br />ONE
<br />1166 Avenue of the Americas E -MAIL
<br />New York, NY 10036 1) �y /��y�+p� p r�,y� ADDRESS: Please see bottom of 2nd page
<br />APPROVED y ED AS L O P N_A`�N, INSURERS AFFORDING COVERAGE NAIC 9
<br />INSURED
<br />SimplexGrinnell LP
<br />12728 Shoemaker Avenue
<br />Santa Fe Springs, CA 90670
<br />United Slates
<br />Laura A. Rossini
<br />Assistant City Attorney
<br />INSURER A: ACE American Insurance Company 122667
<br />INSURER B: Indemnity Insurance Company of North America 143575
<br />COVERAGES CERTIFICATE NUMBER: 1132438 -A 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 />ILT
<br />SANTA ANA, 92710
<br />ADDL
<br />SUD
<br />United States
<br />R
<br />TYPE OF INSURANCE
<br />y!?aP
<br />POLICY NUMBER
<br />MMI�IDY/YYYY
<br />MMIDDYM VPi
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />X
<br />HDO G27326699 (Primary GL)
<br />10/1/2013
<br />10/1/2014
<br />EACH OCCURRENCE
<br />$ $1,000,000.00
<br />PREMISES Eaoccur ante
<br />$ $1,000,000.00
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />MED EXP (Any one person)
<br />$ $10,000.00
<br />PERSONAL &ADV INJURY
<br />$ $1,000,000.00
<br />OWNERS& CONTRACTOR'S PROT
<br />GENERAL AGGREGATE
<br />$ $2,000,000.00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP /OP AGO
<br />$ $2,000,000.00
<br />X POLICY "' FLOG
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />X
<br />ISA H0872264A (All Other States)
<br />10/1/2013
<br />10/1/2014
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$1,000,000.00
<br />BODILY INJURY (Per person)
<br />$
<br />A
<br />X
<br />ANYAUTO
<br />ISA H08722687(NH)(Primary AL)
<br />10/112013
<br />1011/2014
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accitlenp
<br />$
<br />AUTOS AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />X`
<br />X NON -OWNED
<br />HIRED AUTOS AUTOS
<br />Per accident
<br />NEW HAMPSHIRE CSL )
<br />$ $250,000.00
<br />UMBRELLA LIAB
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE PRODUCTS-
<br />$
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION$
<br />NEW HAMPSHIRE (CSL)
<br />$
<br />A
<br />WORKERS COMPENSATION
<br />X
<br />SCF 047323 (WI Only)
<br />10/1/2013
<br />10/1/2014
<br />WC STATU- OTH-
<br />X T RV LIMIT E
<br />A
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR /PARTNEWEXECUTIVE YIN
<br />WLR 0473234488 4 (CA, MA)
<br />10/1/2013
<br />1011/2014
<br />E.L. EACH ACCIDENT
<br />$ $2,000,000.00
<br />B
<br />OFFICERIMEMBER EXCLUDED? N❑
<br />NIA
<br />WLR C47323447(All Other Slates)
<br />10/1/2013
<br />10/1/2014
<br />E. L. DISEASE- EAEMPLOVE
<br />$ $2,000,000.00
<br />(Mandatory In NH)
<br />ryes,descHbeunder
<br />DESCRIPTIONOFOPERATIONSbelow
<br />EL .DISEASE - POLICY LIMIT
<br />$ $2,000,000.00
<br />B
<br />Builder's Risk /installation /Contract Works
<br />N10724429001
<br />10/1/2013
<br />10/1/2014
<br />USE, $1,000,000.00 perjobsite
<br />B
<br />Rental EquipmentlContractor's Equipment
<br />N10724429001
<br />10/1/2013
<br />10/1/2014
<br />LSD $1,000,000.00 perjobsite
<br />B
<br />Blanket Transit
<br />N10724429001
<br />10/1/2013
<br />10/1/2014
<br />USD$1,000,000.00 per conveyance
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Add ltlonal Remarks Schedule, if more space is required)
<br />Project: City of Santa Ana its officers, employees, agents, volunteers and representatives is included as additional
<br />Insured as required by written contract, but limited to the operations of the Insured under said contract, per the
<br />applicable endorsement with respect to the General Liability and Automobile Liability policies.
<br />Please refer to attached ACORD 101 for further remarks.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SANTA ANA POLICE DEPARTMENT
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />60 CIVIC CENTER PLAZA
<br />THE EXPIRATION DATE THEREOF, NOTICE
<br />WILL BE DELIVERED IN
<br />SANTA ANA, 92710
<br />ACCORDANCE WITH THE POLICY PROVISIONS,
<br />United States
<br />AUTHORIZED REPRESENTATIVE
<br />y!?aP
<br />IAA' l✓ 'fMKY.mlrr
<br />MARSH USA INC, BY
<br />Ranklln Halloak, Global S.M.
<br />Jea Cav
<br />Tranei, Pm,a
<br />©1988.2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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