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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MMIDD/YVW)
<br />04/02'2013
<br />C'6AL
<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(les) must be endorsed. If S ROGATION IS WAIV D, 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
<br />Act Ri 51( SerVIC. NOrtheaSt, Inc.
<br />New York NY Office
<br />CONTACT
<br />NAME:
<br />AIC, us.EMy (866) 283-7122 FAIL. NP.: (847) 953-5390
<br />199 Water Street
<br />NEW York NY 10038-3551 USA
<br />EMAIL
<br />ADDRESS:
<br />INSURERIG) AFFORDING COVERAGE NAICM
<br />GENERAL LIABILITY
<br />INSURED
<br />NEC Corporation of America
<br />6555 N. State Highway 161
<br />INSURER A: Columbia Casualty Company 31127
<br />INSURER R, M1t5U1 Sumitomo insurance Co Of AmerlCa 20362
<br />INSURER G`. Mitsui Sumitomo Insurance USA Inc. 22551
<br />Irving TX 75039-2402 USA
<br />INSURER O:
<br />X 0OTE
<br />MMERCIALOENERALOABILITY
<br />CLANISMADE EOCCUR
<br />INSURER E:
<br />INSURER F:
<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 SEAMY 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 OFSUCH POLICIES. LIMITSSHCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested
<br />I.
<br />L
<br />TYPE OF INSURANCE
<br />AUDI
<br />PWD
<br />pOUCY NUMBER
<br />MM1DD1YYYYI
<br />M IVVY
<br />LIMITS
<br />GENERAL LIABILITY
<br />GL
<br />1 2 1
<br />EACH OCCURRENCE $1,000,000
<br />X 0OTE
<br />MMERCIALOENERALOABILITY
<br />CLANISMADE EOCCUR
<br />$300,000
<br />PREMunen
<br />ISEB E¢Pma
<br />MEU IXThat M p¢M $10,000
<br />PCRSONAL6ADVIFIJURY $1,000,00'
<br />GENF.RALAGGREGATE $2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER',
<br />PRODUCTS-COf'DAp AD. $1.000,000
<br />X POLICY PRO LOC
<br />G
<br />AUTOMOBILE LIABILITY
<br />BVR 2
<br />ADS
<br />0401201304/012014
<br />COMBINEDSINGLELIMR
<br />0nealtle 1 $1.000.000
<br />BODILY INJURY (Per parson)
<br />B
<br />X ANYAUTO
<br />RVR 8302206
<br />04/01/201304/01/2014
<br />S
<br />ALL ""'SCHEDULED
<br />AUTOS AUTOS
<br />PA
<br />BVR 8405080
<br />04/01/2013
<br />04/01/2014
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE
<br />Pa... citl¢m
<br />% HIRED % NON OWNED
<br />AUTOS
<br />MA
<br />camprcml Dad $1,000
<br />B
<br />X UMBRELLA BAB
<br />X
<br />OCCUR
<br />UM85000098
<br />04/01/2013
<br />04/01/2014
<br />EACH OCCURRENCE 5,000,00'
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />SIR applies per poli Cy ter
<br />5 & Condi
<br />ions
<br />AGGREGATE $5.000,000
<br />OED I % IRETENTION SSC, 000
<br />R
<br />wORHERS COMPENSATION AND
<br />EMPLOYERS'LIABILITY yIN
<br />PNY PROPRI ETCH I PAR -N IN I EXECUTIVE N
<br />ER
<br />HER E%CLUUEOT
<br />FFICIdary
<br />NIA
<br />NCP9102225
<br />04/01/2013
<br />04/01/2014
<br />WC STATLL OTH-
<br />X TORY LIMITS ER
<br />E. L, EACH ACCIDENT $1,000,000
<br />E.L. DISEASE-EA
<br />EA EMPLOYEE $1,000,000
<br />( mandatory In
<br />RIP71ONibe antler
<br />E s desdION Un OPERATIONS helrnv
<br />E.L. DISEASE-POLICYLIMIT $1,000,'00
<br />*
<br />Internet Liab
<br />4254228490//30/2012
<br />SIR applies per policy ter
<br />s &condi
<br />0//30,/2013
<br />ions
<br />Per Claim/Aggregate 5,000,000
<br />Retention $500,000
<br />DESCRIPTION OF OPERATION51 LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Sehetlule, If area apace Is required)
<br />RE'. The City of Santo Are are named insul'eds with respect to "bodily injury" of "property, damage' claims arising out of the operations pertained by or on behalf
<br />of the named isnured. NEC Col'poration of America, such insurance as is afforded by this policy is primary and is not additional to or COntributing with any other
<br />insumnce carried by or for the benefit Of the additional insured, the City of Santa Ana, provided claims that give rise are from the Named Insured's negligence and
<br />arising out of operations performed for the City of Santa Ana.
<br />`U
<br />CERTIFICATE HOLDER CANCELLATION 9—
<br />SHOULD ANY OF THE ABOVE DESIGNEES POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE
<br />POLICY PROVISIONS,
<br />CITY OF SANTA ANA AUTHORIZED REPRESENTATIVE
<br />ATTN: CARL MAREK
<br />20 CIVIC CENTER PLAZA ���J�(�-{-��
<br />P.0 BOX 1988 t/4KAPL UNl2YE161� ,(/^�m_
<br />M-77 e��/6NL sem/ c./j'
<br />SANTA ANA CA 92701 USA
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />APPROVED AS TO FORM
<br />LISA E. Sl"CRCK�
<br />Assistant City Attorney 1/
<br />f
<br />
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