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"�-_- CERTIFICATE OF <br />LIABILITY INSURANCE <br />DATE(MMIDDiYYYY) <br />11/19/2013 <br />THIS CERTIFICATE IS ISSUED AS AMATTER 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 />INSR <br />LTR <br />IMPORTANT: lithe certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />ADDL <br />NSD <br />PRODUCER <br />ROSEWOOD RISK MGMT & INS SOLUTIONS <br />7162 Beverly Blvd, Ste 180 <br />Los Angeles, CA 90036 <br />OH38577 <br />POLICY NUMBER <br />CONTACT <br />NAME: Yehuda Kaplan <br />AH <br />(MMIODIYVVV) <br />AHO"NOExt: 323 899-3081 (AIc,Na):(323) <br />500-6745 <br />ADDRESS:Ykaplan@rrmis.com <br />COMMERCIAL GENERAL LIABILITY <br />INSURER(S) AFFORDING COVERAGE <br />NAIC# <br />INSURER A: Penn Star InsuranceCom an <br />10673 <br />INSURED National Data and Surveying Services <br />8370 Wilshire Blvd., Ste 205 <br />Beverly Hills, CA 90211 <br />(323) 782-0090 <br />EACH OCCURRENCE $ 1,0 0 OOO <br />West American Ins. Co.(Libe,sy Mutual) <br />INSURER e: <br />44393 <br />INSURER c: Torus National Insurance Company <br />25496 <br />INSURER D: Zurich American Insurance Company <br />16535 <br />INSURER E: Mount Vernon Eire Insurance Company <br />26522 <br />INSURER F: <br />MED EXP (Any oneperson) $ 5 000 <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 />LTR <br />TYPE OF INSURANCE <br />ADDL <br />NSD <br />SLIMHULIG <br />D <br />POLICY NUMBER <br />HULOY <br />(MNV)Dl1'1'YV) <br />AH <br />(MMIODIYVVV) <br />LIMITS <br />X <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE $ 1,0 0 OOO <br />CLAIMS -MADE CI OCCUR <br />PREMISES(�EaRocErrence) $ lOO OOO <br />MED EXP (Any oneperson) $ 5 000 <br />PERSONAL&ADV INJURY $ 1,000,000 <br />A <br />Y <br />Y <br />CPS5041128 <br />$2,500 Ded. <br />9/17/139/17/14 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE $ 2,000,000 <br />X POLICY 0 jE0 CI LOC <br />PRODUCTS -CONFIDE AGO $ 1 000,000 <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />Ea accitlent $ 1,000,000 <br />BODILY INJURY (Per person) $ <br />B <br />XTOS <br />D SCHEDULED <br />X AUTOS <br />NON�OWNED <br />X AUTOS <br />BAW (14) 55 79 09 <br />10/18/13 <br />10/18/14 <br />BODILY INJURY Per accident) $ <br />( ) <br />PROPERTY DAMAGE $ <br />(Per accident) <br />LEXCESSLIAB <br />X <br />LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE $ 5,000,000 <br />`+ <br />CLAIMS -MADE <br />77763H130ALI <br />9/17/139/17/14 <br />AGGREGATE $ 5,000,000 <br />$ <br />RETENTION $ lO 000 <br />D <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETORIPARTNEWEXECUTIVE YIN <br />OFFICERIMEMBER EXCLUDED? ❑ <br />(Mandatory In NH) <br />NIA <br />Y <br />WC9407597-00 <br />9/17/139/17/14 <br />X AT <br />STUTE ER <br />E.L. EACH ACCIDENT $ 1,000,000 <br />E.L. DISEASE- EA EMPLOYEE $ 11000,000 <br />byes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE POLICY LIMIT I $ 1,000,000 <br />E <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe atlachedif more space is required) <br />City of Santa Ana its officers, employees, and agents are provided additional <br />insured status on a primary and noncontributory basis as required by written <br />contract or agreement. A Waiver of Subrogation is in favor of the additional <br />insured. <br />30 Days Notice of Cancellation, 10 Days for Non Payment of Premium. <br />CERTIFICATE HOLDER CANCELLATION <br />City of Santa Ana <br />20 Civic Center Plaza -Ross <br />Amex, M-43 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana, CA 92 p� <br />�5.1'RUVIED <br />AS 'TO FOR <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />1 <br />OR ON 0 <br />ON <br />AUTHORIZED REPRESENTAT <br />A.q t �tt .. t-- :E--- -T� © 1988-2013"ACORD CORPORATION. All rights reserved. <br />ACORD25 (2013/04) YrIne �C�R name andTloeygb are registered marks of ACORD <br />