Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
PETERSON GROUP, THE 1B - 2011
cv 1 �i v al. J d l� v a MAYOR — �7— LVI e- %§59CE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES MAYOR — Z7— 201 Z Miguel A. Pulido CLERK O�IFCOUNCIL MAYOR PRO TEM DATE: MAY 1 0 2011 Claudia C. Alvarez COUNCILMEMBERS David Benavides Carlos Bustamante i JL'F74jimv�ai 3. c Michele Martinez CITY OF SANTA ANA Vincent F. Sarmiento Sal Tinajero PUBLIC WORKS AGENCY M -21 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702 (714) 647 -5690 April 6, 2011 Mr. Alan Peterson, Jr. The Peterson Group 2 Corporate Plaza, Suite 150 Newport Beach, California 92660 Re: Marketing and Public Education Services Agreement Dear Mr. Peterson: A- 2008 - 305 -002 This letter will confirm your April 4, 2011 telephone conversation with Christy Kindig through which The Peterson Group and the City of Santa Ana have agreed to extend the term of Agreement A- 2008 -305, dated November 17, 2008 until such time that allocated funding has been expended. The insurance certificates and Additional Insured Endorsement are required to be extended and /or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. If you have any questions in this regard, please feel free to contact Projects Manager Christy Kindig at (714) 647 -5088. Sincerely, Raul Godinez I Executive Dire or, Public Works Agency Approved as to Form Laura Sheedy Assistant City Attorney ATTEST: MARIA, D. HUIZAR CLERK OF THE COUNCIL CERTIFICATE OF LIABILITY INSURANCE 111111ADMI A4co CERTIFICATE OF LIABILITY INSURANCE °"'1�" 017142011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, MI END OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING W SURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER NNPORTANT: N the eortifkate holdor M m ADDITIONAL INSURED, Um poll y('Irla) must be wMorssd. N SUBROGATION IS WANED, suh(set to RAs terms and cosdWom of dw policy. corleln Pelicks NW arltdrs m sndorssnwnL A snwosid an this artBieW doss 110L eooW dglts to tip aor9Neals holder M Im1 M such mldmssnwld(s). PR0°°M woe ANDREW W MORRIS - (949)17042111. Fa (919470 -2120 rFlvE SRS FAX -- SUPERIOR ACCESS INSURANCE SERVICES NC cwAa 5 OLDFIEID EiD10Qilw@iE CA M618 MOUNEM AFFOIwri - —Ammms wsarlelA; HARTFORD CASUALTY NC CO 22424 s ®a® THE P(:T9250N GROUP INC Mraas: is 2AW.0110 w c' OEIIDIK AGfa'//fGATE 2 CORPORATE PLAZA OR SLATE 150 Fm /®to: 74 NEWPORT BEACH. CA 02680 , R AviasosALSUNNr `ALLOSr® SCHEDU1® A --i ce �'�� j X' sann&g+wmoE %C ALITM A -2008 -305 MlratEN F 72SBAN11945 o1284Dil 199'/9 alr �gq[41I]U{dlZXap'cI4: -1_q r�r�naTn - THIS IS TO CERTIFY THAT THE POLICES OF RMIRANCE LEND BELOW HAW BEET 15511® TO THE INSLOIED NMIED ABOVE FOR THE POKY PERIOD INDICATED. morn HSTANDING MY IEOIIIRI ENT, TERM OR CONDITION OF AM CowRACT OR OTHER OOCtsm" WITH RESPECT TO V&SCH TLS CMIFICATE MAY BE SMIED OR AMY PEREW. THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN S 3UBECT TO ALL THE TERMS. EXCLUSIONS ARLCOIDI IONS OF SUCH POLICES, . LYTS SHOWN MAY HAVE BEEN REDUCED BY PADCLAI6. Ln TVMCF�IMefB i 1 r'FiICT m rQ1Cr@ ) l/Iw. C®M \llAfA1T I iR u1sEAaAt GEHgML WILAY Ir� I CWAISWDE M OCCUR + I 72SBAAA1945 0121102011 OUZOM12 EiD10Qilw@iE S S 4m EAP aea osl 510000 I¢NOHMtaAarslwNr is 2AW.0110 GENLAGGREGATE TAR APPLIES PER X i Pour, -r n La OEIIDIK AGfa'//fGATE 1 s4,0O4tIO0 RYm4C15- m1iVpPAGG 74 , R AviasosALSUNNr `ALLOSr® SCHEDU1® A --i ce �'�� j X' sann&g+wmoE %C ALITM ,p .. I f 72SBAN11945 o1284Dil !01294012 BO�r NA/R Pra�ne s l s UMMkEJA EXCEN 11A9 a<A EAIM oaxiNe1m S AOBE"TE L OD iEMNTMS 5 11rONUM COWMEN 7m ANY � rI4 O:FIOEwBIBl rXMu im.dMbeiy r,w daft.ele NIA f w fig EL EACH ADCiHm S ELOISEASE-E&EMPLWO "S EL IX EAST -PM1 LMR S o FM IVIed+ACOIN R9t»16 QERAT ®IGd'�71aSlYNaGES aararrAOYn�q CNB cafe H ida added as AIdbNol 4M1aed Laura Stitt ShA` rue) Assistant City CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA. CA 82701 RarEielrwme ACORD 25 (2i WOO The ACORD rrwlle and logo an rspls» red marks M ACORD (7nmmpri-bi C;ertifiritp of Tnsnranrp 04/11/2011 08:56 17147313808 INSURANCE AGENCY V A D AI C D C- 03473 P.001 /001 5e.2492 4{ 4 Copy llistribution: Service Center Copy and Agerits Copy Fax from : 17147313886 04/11/11 H41 18:48 Psi: 1 Commercial Certificate of Insurance FARM s R5 icy , ALLINSON INSURANCE AOF,NCY 8/11 Name . 14151 NEWPORT AVE #101 2Jjj Pj�Y —1I "3 (MWDD/YY) 04i L & • TUSTIN, CA 92780 only arnd Nrskrs n0 tlglit5 Address . 714 838 2860 "Thb certifip[e is isued as a matter of infcrcmtio _ upon the ontQaie tWlii'r- This cealticam does amend. extend or alter do St. 97 DCSL �' Agent 323 coverage afinrded hV!the Policies shown below. �:_ L. .- . Companies ProvltCmg Coverage Insured i�°`aP ° ^Y A Tmcl:Insuar!ec Esc";" . THE PETERSON GROUP Name . #2 CORPORATE PLAZA DR. 150 �ty*y B Fanners Insurance �hmnge & . NEWPORT BEACH, CA" 92660 C—,rranv C Mid - Century haaaa ce Company Address D cry nt(^nC " ` Coverages �— This is to certify that the policies of insurance listed below have boss issued to the imiued named above for the policy period icated. Notwithstanding any requirement. term or condition of any comsat-: or ocher doormen wirh respect to which this certificate may be issued or 1�ay pertain, the ifuutance afforded by the poll= described herein as subject to all the terms, eacl®om and conditions of such policies. Limits shows may have been reduced by paid claims. Ur. Type of Insurance Policy Number Polity MwDD Date � fm Ceiva-altB87egur y Limits E General Liability ._...i Comowoal General Produce -Comp Aggfer: YS 3 Orcurrerce Vernon I Advertising l*'D' I S Cdmaractual - Incidental I Each Oa.7trreree $ i Onh, Fire DanrW ca gel E Owners & Contractors Prot- Medical Medal (Any out pal - 3 Automobile Ua biky Combined Sing ALL Owned Commercial LIMA Autos . Bodily Injury i Scheduled Auto I (Papuson) S Hired Autos - Booty 1111 (Per as:ddentl S Non -Owned Autos Gaze I talai ily Property Danaai� $ Gaardeee PWepir $ - _... -__. Umbrellaliabiity MIE A i Wtlrkess'CompensaUOn A01097222 04!11/11 04/11/12 EachAcy ach ddesn I .3 1,000,000 and Employers' Uablllty Disease - Ex" taiee $ 1,000,000 Disme _ pokey Park 3 1,00(1.000 Description of Opentlnrtc /VeMdes/Re&mctiorm/Special ltem \PPROvEo AS 'I'O FORM i Certificate Holder CanceilaGoni -aura Suit Site y . CITY OF SANTA ANA Should any of dlaabeac d+§'m rApbfiafsitx �ancelit�' pekte the expiration date Name . 20 CIVIC CENTER PLAZA th®mL the issuing mmpany will endeavor to mail 30 wftm notice to the & • SANTA ANA, CA- 92701 certificate holder named to the W but failum to bilty of arty kind the company. aaia notice shall impose no amrs � Mrtm- Address Mg or . AuMMzed Represilintative 5e.2492 4{ 4 Copy llistribution: Service Center Copy and Agerits Copy Fax from : 17147313886 04/11/11 H41 18:48 Psi: 1 �� .4��RO CERTIFICATE OF LIABILITY INSURANCE °A'E°r"'°°""/''"' 41�a1rzolz THIS CERTIFICATE IS ISSUED AS A BATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXPEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE- IVVEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER77FICATE HOLDER_ IMPORTANT= If th® certiBCatB holder Is an ADDITIONAL INSURED, the pollry {ies) must tre antlonsod_ H SUBROGATION IS WAIVED, subJect to the terlrls and condltlons of the policy, wrialn polielas may reQuire an endorsement A statanreM on ifris certificate does not confer rig hls to the crartlfleate holler in lieu of such endorsemrNlt(s1_ pROOUCER (949}470.2111, Fax 949 ( )470.2125 SUPERIOR ACCESS INSURANCE SERVICES INC 5 OLDFIELD NAMEA� ANDREW W MORRIS _ PHONE _ _ � � �WC, No�R�'MR.5 -S-1 5n E�IIA/L - --- AOOHE55: Rrtvsrri_ai�rarmBf.S j}PDI r'.rni ......._ . _._. � —�- INSURER[S)AFFOROWG COVERAGE ___._ __ NAlC i1 IRVINE CA 92618 __._. .. ____ _.... _ WSURER A c__HARTFORD CASUALTY INC CO __ _.._.__ __. 2942d _._____ WsuREn THE PETERSON GROUP INC WsuR> =R a : —_ ___.__ InsuRER c � 18851 BARDEEN AVENUE SUITE 225 __ WsuRER O =_.___ _ IRVINE, CA 92612 INSURER E : - ._.___ _ 3 � - - � o rr�rcroA r_vo �_�_.___ _ __ _._ __ _ -- _ -- W suRt3t F - r.aimocrt= THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO \/E FOR THE POLICY PERI00 IN DICATEO. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 45 SUBJECT TO ALL THE TERMS, EMC LUSIONS AND CONDITIONS OF SUCH POLICIES_ LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF N1$i)RANCE $U PpLKY MllY6Eia YINiOWYI W LYTS GBrFenr LUUrrLITY � x EACH OCCURRENCE 5 QOD ODD I PR MI En orsrrerlrE S 0� COMrrERGAL GENERAL.LWBILITY X I1--�, CLAIMS -MADE n CUR ___..: •����� A YED EXP (Any me person) 5 10000 pER50NAL &ADV INJURY 5 2000000 __ 7258AAA1945 D12924'12 07/292013 —� -- GENERAL AGGREGATE ____ S 4,OOD,000 ' GENT AGGREGA /E LRirIT APPLIES PER: ' PRQ PRODUCrs- GOrrPlOP AGG s 4 0D ___ X POLICY LOC y AUIpYOBrLE LlAO_ITY M � � MBI LE LIMIT ��� _040.000 __ ANY ALRO ... _.— ... __. BODILY INJURY lPar pion) _a_2 S _._ ALL ONNEO SCMEUULED _____ _ ! BoDILY WJUBY ipv amamu) �� s A x AuroS AUTOS ED 72SRAAA1945 01292412 0129/2019 -..... HIRED AUTOS X A�U'fN� Ate` Pv ac/a.ng i S � UOBRELLA LUU! OCCLA3 � �_. EACH OGCLriREJVCE S E1GE55 LOB CLMYSaNADE r_._ AGGREGATE - __._..._. S '. OED RETENTIONS -. I �. —_.__ ___._ S WORr(ERS CONPENSATIOI11 t N,C STATU- DTI+ ANO EWLDYHiS LIABI..D'Y Y/ N � �� _ E.L. EACH AL` NT � i __ _. _ _ t ANV PROPRIETOWGARTNERIEJfECl1TVE OFFIGE/rrENBEA E%CLUO @V � N / A r ' E.L OISFA4E - FA iJNF'LDYE ____ E IMe�A In NM Ir �� �� ufbe/ E..L DLSFASE - POLCY LIMIT _ S OESfJf1RTd1 OF GPrAAT/pN$ / IOCIrT1OM$ / VEM14i£S iAm¢Ii AGO {m lM_ ACfWOOwr rcenv�p —. W ter. s•WCe I6 AquFrd) CERIFICATE HOLDER ADDED AS ADDITIONAL INSURED CITY OF -SANTA ANA �S9 LS (BI D. C L,l Ly A 1 I t> r C \ SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EZPIRATrON GATE THEREOF, NOTICE W�L BE DELNERm IN 20 CIVIC CENTER PLAZA ACCORDANCE 1111ITH THE ➢OLIGY PROVISiOTi3. SANTA ANA, CA 92701 REPRESENTATNE ''[O !� ��-.rF ®'19'88 -2Di0 ACORD CORPORATION. AIf rights ruasrvarl. h�..vrtv <o t <uT rr +rral r rNa Acos� name acrd logo aro rogistered merits oT AGORD f�_ _1Q� JYP /1k__ CERTIFICATE OF LIABILITY INSURANCE R045 DATA(MM/DD /YYYY) 1I /zo /zo13 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SUPERIOR ACCESS INS SRVC INC /PHS 181840 P: (866) 467 -8730 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: UVCNEo,Eap. (866) 467 -8730 (AAIO,Na): (888) 443 -6112 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL# INSURERA: Sentinel ins Co LTD POLICYEXP INSURED /{.J� 1'T //�� } y1 ///� ' / Aov/ - } 195 r/ (/ THE PETERSON GROUP INC. 18851 BARDEEN AVE * 225 IRVINE CA 92612 INSURER B: GENERAL INSURERC: INSURER D: INSURER E: INSURER F: $2, 0001 000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE ADDL INSM SUER MEMO POLICYNUMBER OLIO EFF POLICYEXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $2, 0001 000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR pREM SES En occurrence $1, 000/ 000 MED ESP (Any are person) $10, 000 X X PERSONAL &ARM INJURY $2, 000, 000 A General Liab 72 SBA AA1945 01/29/2013 01/29/2014 GENERALAGGREGATE $4, 000, 000 AGGREGATE LIMIT AP PLIES PER: GEN'L PRODUCTS- COMPIOP AGO $4, 000, 000 $ POLICY PRO- X LOC JECT AUTOMORILELIABILI]'Y COMBINED SINGLE LIMIT (Es accident) 52 000 000 / r BODILY INJURY (Per person) $ ANY AUTO A Au OWNED SCHEDULED Auras AUTOS 72 SBA AA1995 01/29/2013 01/29/2019 BODILY INJURY (Par scalaem) $ PROPERTY DAMAGE (Par eooldanl) $ HIREDAUTOS X NON -OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE A PROVED AS TO ,� � AGGREGATE $ DOD RETENTION$ $ IYOFN£RYCOANTEPSdTION ANDPMYLOI'ERS'LIABILITY / WC STATU- OTH TORY LIMITS ERS E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE YIN _ OFFICER /MEMBER EXCLUDED? Mandatory in NH) ❑ NA .�._. ,aU a Stltt Sheedy _ E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below Assistant City AttOSA..y' E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (MAX Lfne Len9fh Is 79; Affach ACORD 101, ACtllflonal Remarks Sch.R.In, I(mare spat. is ra, iro f) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Santa Ana 20 CIVIC CENTER PLZ SANTA ANA, CA 92701 ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERTIFICATE ,, LIABILITY INSURANCE U.A 1 41E.1WI M A6015/ry1 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER„ AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol'icy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and Conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PPODUCER 'cr3NtACr NAME SUPERIOR. ACCESS INS SRVC INCIPHS PRONE FA AAIC,WEA)T (866) 467 -8730 AC,NOe: (888) 443 -611.2 181840 P: (866) 967 -8730 F: (888) 443 -6112 AOR5S: PO BOX 33015 INSURERIS9 AFFORDING COVERAGE NAICII SAN ANTONIO T 78265 ¢NSVRERA ;gent ine` Ins Co f 7a 1_4I00 INSURED tlNSURER 8 . '.... EACH OCCURRENCE G2, 000, 0 0 0 INSURER C: THE PETERSON GROUP INC. INSURER 18851 BARDEEN AVE # 225 INSURER E: IRVINE CA 02612 INSURER F. X COVERAGES CERTIFICATE NUMBER: REVigfnK] NIMARIRR, ..... _ . _ .. . _..._-- -. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT', TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISSR F"I'Pk' oil, rNS1 RANCH IUDL SULIR ' F@LIC'TNCURER POLIC9'EFF Vt1✓D01Yf �YY FDLICI'11,1 "P ,.„ LIMITS COMMERCIAL GENERAL LIABILITY '.... EACH OCCURRENCE G2, 000, 0 0 0 CLAIMS -MADE I ^''* I OCCUR El k7AMIA�� TO R ENTEp ... PREI ISE9 Ee pceuFren.., � a 1. r 0 0 0 r 00 0 X x NEDEXP(Anyoneperson,) 410,000 A General Data 72 SBA AA1945 01/29/2414 01129120''5 PERSONAL 11. AOVF INJURY s2, ..._ 000, 0 (} I] GEN'L GAT AGGREGATE LIMIT APPLIES PER: POLICY PRO- C- LLOG, JE ',........ GENERAL AGGREGATE, ;, 4 I. 000, 0 0 0 PRODUCTS , COMPIOP AGO o 4 I 0 0 Q J 000 OTHER; AUTOMOBILE LIABILITY COMBINED SNNGLE LIMIT (Ea accident) rr, 5 r 0 0 I^r U 0 , U ANY AUTO BODILY INJURY (Per keeraonW 'b` At OYdNED SCHEDULED AUTOS AUTOS "72. SBA AA1945 O'_/29/20141 (j. /29/.2 C+ 5 BODILY INJURY (Per accident) g. X HIRED AUTOS X NON - OWNED AUTOS PROPERTY DAMAGE (Per accldenl) UMBRELLA LIAR OCCUR EACH OCCURRENCE s EXCESS LIAB CLA.IM&MADE AGGREGATE GE REMN'H.N5 S IVUR&ERS Cff i/PEAWATION J,1'h Etfw^LflyF.NS "L6A0NLITr OFFICERIMEMBER EXCLUDED? I'Mandafa R`nT�N�PARTNERIEXEDUTIVE ry ) Yes, describe under DESCRIPTION OF OPERATIONS belay N/A 1� d., �, r� / - t ;hL' Sand Cb"w� PER ER I 107H' F.R rr ...... E.L. EACH A GII) .L� DISEASE• EA EMPLOYEE ' E -. LICY j(- LIMIT DESCRIPTION OF OPERATIONS' /LOCATIONS /VEHICLES (ACORD 101, AddlUonal Ro.ks Schedule, maybe attached If more space Is requlrodl Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. 19611.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE City c f Santa Ana DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 20 CIVIC CENTER PLZ SANTA ANA, CA 02701 19611.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS` COMPENSATION INSURANCE ISSUE DATE: 06 -30 -2014 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ SANTA ANA CA 92701 -4058 GROUP: POLICY NUMBER: 9094902 -2014 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 04 -11 -2015 04- 11- 2014/04 -11 -2015 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form apprdved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We wN also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - PETERSON UR. , ALAN M PRES SEC TRES - EXCLUDED, EMPLOYER THE PETERSON GROUP INC. DBA: THE PETERSON GROUP, INC. 188551 BARDEEN AVENUE IRVINE CA 92612 [VM5,C5] IREV.1 -20121 PRINTED : 06 -30 -2014 A-2008-305-002 CERTHOLDER COPY SP CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-30-2014 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 GROUP: POLICY NUMBER: S094902-2014 CERTIFICATE lf) 3 CERTIFICATE EXPIRES: 04-11-2015 04-111-2014/04-li-205 ThW is to certify that we have Issued a valid Workers' Compensatlon Insurance policy in a form approved by the California insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer, We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration, This certificate of insurance is riot an insurance policy and does not arriond, extend or alter the coverage afforded by, the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which 4 may pertain, the insurance afforded by the policy described herein is subject to all! the terms, exclusions, and conditions, of such pokey, Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - PETERSON JR. , ALAN M PRES SEC TRES - EXCLUDED. 6 THE PETERSON GROUP: A�RE NT # A-2008-305-002 REVIEWED BY: EUNICE HEREMA (pg. 1 of 1) —05-7- EMPLOYER THE PETERSON GROUP INC. OISA: THE PETERSON GROUP, INC. 18851 BARDEEN AVENUE IRVINE CA 92612 [VM5,CS] lR Ev, 1 -20 12) PRINTED : 06-30-2014 Policy Number: A0109 -72 -22 Data Entered: 11/18/2013 AeoR®® CERTIFICATE OF LIABILITY INSURANCE Ill DATE(MMIDDIYYYY) 11/18/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brad Hume Insurance Agency 23231 South Pointe Dr #101 Laguna Hills, Ca 92653 CONTACT NAME: FAX (949)830 -7970 ,vc Net: (949)830 -9746 EMAIL ADDRESS: ,� S A °`'� yy f o *o ' q ()J INSURERS AFFORDING COVERAGE NAIC p INSURER A: TRUCK INSURANCE EXCHANGE $ MED EXP(Any one person) INSURED THE PETERSON GROUP, INC. INSURER B: $ INSURER C AGGREGATE INSURER D: GEN'L AGGREGATE LIMIT APPLIES POLICY SECT_ 18851 BARDEEN AVE #225 INSURER E: $ IRVINE, CA 92612 dl ..D �70 j�.op^ �•V •1 •Y INBURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADbL INSR SUBS WVD POLICY NUMBER POLICY EFF MMIDWYYVV POLICY EXP MMIDDNYYV LIMITS ATTN: GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-IOCCUR P.O. ,� S A °`'� yy f o *o ' q ()J EACH OCCURRENCE $ PREMISES Eacccurrence $ MED EXP(Any one person) $ PERSONAL B ADV INJURY $ AGGREGATE GEN'L AGGREGATE LIMIT APPLIES POLICY SECT_ PER: LOG PRODUCTS COMWOP AGO $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NONOSOWNED \ .. .wT v�ilpTa. "� y1Sl.atlt. ,,SJ t�CU11CC L]S /a,CL09 (;11.Y ,,,, „,.. t ?C' '° COMBINED SINGLE LIMIT Eaacciden[ BODILY INJURY (Per person) $ BODILY INJURY (Per accldenQ $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ BED RETENTION $ IS A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDEOP (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA A0109 -72 -22 04/11/2013 9/11/2019 WC STATU- OTH- TORY LIMITS E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE EA EMPLOYEE $1,000,000 E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.cotm Impressive Publishing 809- 208 -1977 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA PUBLIC WORKS AGENCY ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: CHRISTY KINDIG, PROJECTS MANAGER P.O. BOX 1988, M -21 AUTHORIZED REPRESENTATIVE SANTA ANA, CA 92702 ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.cotm Impressive Publishing 809- 208 -1977 THE PETERSON GROUP A-2008-305-002 REVIEVVED EIY: IA' /16�1 1- -- - EUNICE HEREDIA I'Pr 1 OF Q� DATF (NIIV YN CERTIFICATE OF LIABILITY INSURANCE 5 /5'/ 2015 DW� V) THIS CERTIFICATEtS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SUPERIOR ACCESS INS SRVC Tl\]C/PHS 1,R1840 P: (866) 467-8730 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX '78265 CPNTACi .112 PHONE �NCN..Edl, Q866) 467-8730 QnC.Nay (8A8) 44:36112 ff-MAIL AD(DRS55, INSURER(S) AFFORDING CCVERA3E NAIC# INSURER A S�_,LL Tns C,D LTD POLI(TV VVBER INSURED THE PETERSON GROUP INC. 18851 BARDEEN AVE 4 225 IRVINE CA 92612 INSURER 8 I LLVI ES INSURER C INSURER[) INSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLU S IONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IASR /zR TYPE Or INSURANCT 4DDL SUBI? POLI(TV VVBER P0110 D/I I 11"I TI't, ) O(JI/D POLICIEEN11 I LLVI ES COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE ;2,000,000 CLAIMS-MADE F, OCCUR UANAGE TO E�EMISESI=11) *1, 000, 000 x MED EXP (Any PS—) 4101 000 * General Liab x 7t S F31 A kA 9, 0112912,015 D1/2912016 PERSONAL & ADV INJURY ,2, 000, 000 LIM IT APPLIES PER: GENERAL AGGREGATE 'A' 000, 000 M'L.AGG11 "'Y PRO- LOC JECT El PRODUCTS - COMPJOP AGG A, 000, 000 AUTOMOBILE LIABILITY COMBINED $NGLF LIMIT (E. —id-t) 2, 0i1()' , 000 BODILY INJURY (P,, p,-) ANY AUTO * ALL OWNED SCHEDULED AUTOS AUTOS "12 PA PAI'1 45 1. 9 2 0 1 o1 0 i 6 UOUILY INJURY (P�rddt) PROPERTY DANIAGE X HIRE[) AUTOS 1`;: NON-OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS UAB AGGREGATE ❑1 kET[N71CII 11081W NOPIPFW710Y PE I :1'D 1-11PLOILMS'Ll MRfil .1 1,'I'l I I E ER7 E.L. EACH ACCIDENT ANY PROPRIETORJPARTNERIEXECUTIVE YIN OFFICERtIVEMBER EXCLUDED? r___1 (MandiUory in NH) N(A E L DISEASE. EA EMPLOYEE 11 yes. descfte UndeI DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY UMq DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORO 101. Addifi—I Rks S� l .. luf , •y be atiacbed if p... iq,ftad) Those Lisual to the Insured's Opprations. Certificate Holder is rin Additicnial. Insured per the Business L.J.ability Coverage Forin S`:-a0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cit'77 of Sarita Ana 20 CT111C CEN7ER PT SAiJTA ANA, CA 92701, @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD THE PETERSON GROUP A-2008-305-002 REVIEVVED BY: POLICYHOLDER ... EUNICE OEREDIA (PG 2 OF 9) SP MENESSIMM CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-11-2015 GROUP: POLICY NUMBER; 9094902-2015 CERTIFICATE Q 3 CERTIFICATE EXPIRE& 04-11-2016 04-11-2015/04-11-2016 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 -This is to certifV that vve- have issued ._a valid Workers' Compensation insurance policy in a form approved by the California 4nGUrance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give. you 10 days advance notice show1d this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such poiicy, h - t��-- lezl Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT 41600 - PETERSON JR. , ALAN M, PRES SEC TRES - EXCLUDED, EMPLr-)YER THE PETERSON GROUP INC. DSA, THE PETERSON GROUP, INC. 18851 BARDEEN AVENUE, SUITE 225 IRVINE CA 92612 PRINTED : 03--17-2015 fIEV.7-2010 THE PETERSON GROUP A-2008-305-002 REVIEWED BY Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyh older, please cal I us at: (866) 467-8730 Agent, please call us at: (866) 467-8730 SERV ICE .TX@THERART FORD .COM ATTALWED- *** PLEASE REVIEW THE CHANGE *** EUNICE HEREDlA (PG 3 OF 9) Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholider, please call us at: (8 66) 467 -8730 Agent, please call us at: (8 6 6) 467 -8730 between 7 A, M, and 7 P.M. CENTRAL TIME The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. SUPERIOR ACCESS INS SRVC INCIPHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Are Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 THE PETERSON GROUP A-2ooe'nosnmzREV�evvEoBY: POUCYNU01BER: rz aaA AA194s THIS ENDORSEMENT IS ATTACHED TO AND MADE PART CJF YOUR POLICY KN RESPONSE TD THE DISCLOSURE REQUIREMENTS OFTHE TERRORISM RISK INSURANCE ACT. PISCLOSURE PURSUANT TO TERRORISM RISPI INSURANCE ACT SCHEDULE Terrorism Premium: ¢a6.00 A. Disclosure QfPremium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRN).waare required to provide you with o notice disclosing the portion o( your pmmium, if mny, attributable to uowanmge for "certified ado of terrorism" underT0A. The portion of your premium attributable 0o such uuv*nmge is shown in the Schedule of this endorsement. B. The following definition is added with respect to the provisions /f this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Trmauury, in accordance with the provisions o[TR|A. to be an act of terrorism under TR|A. The criteria contained in TRUA for a "certified act of terrvhem"include the foHoxxim0: a. The act reemkw in insured |uowea in o»ooms of$5million in the aggpeAmt*, aUribmtab8v10 all types of insurance subject toTR|A;and b The act results in damage within the United 8betem, or outside the United States in the nnso of certain air carriers or vessels or the premises ofmm United States mission; and o. The not is m violent act or an act that is dangerous to human 8fe, property or infrastructure and is committed by on individual or individuals ao part cf an effort to coerce the civilian popmlmfion of the Form SS 83 76 01 15 United States or to influence the policy affect the conduct of the United States Government byouandon C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for o portion of insured looeeo, as indicated in the table ba|ow, attributable to "certified acts oftvrrohmm°under TR|A that exceeds the mppIioob|e insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses under TRi4 exceed $100 billion in a calendar year, the Treasury shall not make any payment for any por6on of the amount of such Vonaea that exceeds $100 Wien. The United States government has not charged any premium for (heir participation in covering terrorism losses. @2015' The Hartford (�cludes copyrighted material of the Insurance Services Office, Inc., with its permission.) S�� THE PETERSON GROUP A-2008-305-002 REVIEWED BY `Ae' EUNICE HEREDIA (PG 5 OF 9) D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIG exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIG, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based an its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates, E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 Page 2 of 2 THE PETERSON GROUP A-2008-305-002 REVIEWED BY: EUNICE HEREDIA (PG 6 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 72 SBA AA1945 DX Named Insured and Mailing Address; THE PETERSON GROUP, INC, 18851 BARDEEN AVE # 225 IRVINE CA 92612 Policy Change Effective Date-. 01/29/15 Policy Change Number: 001 gent Name: SUPERIOR ACCESS INS SRVC INC/PHS Code: 181840 Effective hour is the same as stated in the Declarations Page of the Policy. POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 SEE FORM IH 12 00 PRO, RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 O4 05 T Page 002. (CONTINUED ON NEXT PAGF) Process Date: 05/07/15 Policy Effective Date: 01/29/15 Policy Expiration Date': 01/29/16 THE PETERSON GROUP A-2008-305-002 REVIEVVFE) BY. EUNICE HEREDIA (PG 7 OF 9) Policy Number: 72 SBA AA1945 Policy Change Number: 001 FORM NUMBERS OF ENDORSEMENTS DELETED AT ENDORSEMENT ISSUE:: SS 50 19 03 12 SS 83 76 03 12 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: ISS 50 19 01 is SS 83 76 01 is Form SS 12 11 04 05 T Page 002 Process Date: 05/07/15 Policy Effective Date: 01/29/15 Policy Expiration Date: 01/29/16 THE PETERSON GROUP A-2008-305-002 REVIEWED BY: EUNICE HERED[A (PG 8 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM! UMBRELLA LIABILTY PROVISIONS A Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of such insured losses, as indicated in the table below that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 201'8 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses, attributable to "certified acts of terrorism" under the federal Terrorism Risk Insurance Act, as amended (TRIA), exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion, The United States government has not charged any premium for their participation in covering terrorism losses. B. Cap On Insurer Liability for Terrorism Losses A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of federal Terrorism Risk Insurance Act, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following; 1. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance Subject to TRIA; and Form SS 50 19 01 15 2. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and 3. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals acting as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. C. Application Of Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or emission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form or Policy, such as losses excluded by the Pollution Exclusion, Nuclear Hazard Exclusion and the War And Klitary Action Exclusion. @ 2015, The Hartford (includes copyrighted material of Insurance Services Office, Inc. with its permission) Page I of 1 THE PETERSON GROUP A -2008- 305 -002 REVIEWED BY: POLICY NUMBER: 72 SBA AA1945 EUNICE HEREDIA (PG 9 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. , PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION KSL, KSL LA COSTA RESORT CO, LLC; KSL LA COS'T'A DEVELOLDMENT CORPORATION, AND KSL LA COSTA PARENT, LLC 2100 COSTA DEL MAR ROAD CARLESBAD, CA 92,009 ATTN: CFHEVIS HOSEA, LOC 002 BLDG 001 COUNTY OF LOS ANGELES DEPARTMENT OF PARKS AND RECREATION US ARMY CORPS OF ENGINEERS 823 LEXINGTON- GALLATIN ROAD SOUTH EL MONTE, CA 91733 THE INSURED IS DOING WORK ON A CONTRACT WITH THE CITY STONEWOOD PROPERTIES 3636 BIRCH STREET" STE 180 NEWPORT BEACH, CA 92660 L00001 BLDG001 CITY OF HOPE 1500 E DUARTE RD DUARTE, CA 91010 CITY OF SANTA ANA 2'O CIVIC' CENTER, PLAZA SANTA ANA, CA 92701 XEROX CORPORATION ITS AFFILIATES SUBSIDIARIES' COMPANIES AGENTS EMPLOYEES OFFICERS DIRECTORS ANY APPLICABLE LANDLORD AND ANY APPLICABLE XEROX CLIENT 800 PHILIPS ROAD, MIS 0205/99P WEBSTER, Nil 14580 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Faye 001 Process Date: 11/12/14 Expiration, Date: 01/29/16 a.: THE PETERSON GROUP A-2008-305-002 REVIEVVED EIY: IA' /16�1 1- -- - EUNICE HEREDIA I'Pr 1 OF Q� DATF (NIIV YN CERTIFICATE OF LIABILITY INSURANCE 5 /5'/ 2015 DW� V) THIS CERTIFICATEtS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER SUPERIOR ACCESS INS SRVC Tl\]C/PHS 1,R1840 P: (866) 467-8730 F: (888) 443-6112 PO BOX 33015 SAN ANTONIO TX '78265 CPNTACi .112 PHONE �NCN..Edl, Q866) 467-8730 QnC.Nay (8A8) 44:36112 ff-MAIL AD(DRS55, INSURER(S) AFFORDING CCVERA3E NAIC# INSURER A S�_,LL Tns C,D LTD POLI(TV VVBER INSURED THE PETERSON GROUP INC. 18851 BARDEEN AVE 4 225 IRVINE CA 92612 INSURER 8 I LLVI ES INSURER C INSURER[) INSURER E. INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLU S IONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IASR /zR TYPE Or INSURANCT 4DDL SUBI? POLI(TV VVBER P0110 D/I I 11"I TI't, ) O(JI/D POLICIEEN11 I LLVI ES COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE ;2,000,000 CLAIMS-MADE F, OCCUR UANAGE TO E�EMISESI=11) *1, 000, 000 x MED EXP (Any PS—) 4101 000 * General Liab x 7t S F31 A kA 9, 0112912,015 D1/2912016 PERSONAL & ADV INJURY ,2, 000, 000 LIM IT APPLIES PER: GENERAL AGGREGATE 'A' 000, 000 M'L.AGG11 "'Y PRO- LOC JECT El PRODUCTS - COMPJOP AGG A, 000, 000 AUTOMOBILE LIABILITY COMBINED $NGLF LIMIT (E. —id-t) 2, 0i1()' , 000 BODILY INJURY (P,, p,-) ANY AUTO * ALL OWNED SCHEDULED AUTOS AUTOS "12 PA PAI'1 45 1. 9 2 0 1 o1 0 i 6 UOUILY INJURY (P�rddt) PROPERTY DANIAGE X HIRE[) AUTOS 1`;: NON-OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS UAB AGGREGATE ❑1 kET[N71CII 11081W NOPIPFW710Y PE I :1'D 1-11PLOILMS'Ll MRfil .1 1,'I'l I I E ER7 E.L. EACH ACCIDENT ANY PROPRIETORJPARTNERIEXECUTIVE YIN OFFICERtIVEMBER EXCLUDED? r___1 (MandiUory in NH) N(A E L DISEASE. EA EMPLOYEE 11 yes. descfte UndeI DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY UMq DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORO 101. Addifi—I Rks S� l .. luf , •y be atiacbed if p... iq,ftad) Those Lisual to the Insured's Opprations. Certificate Holder is rin Additicnial. Insured per the Business L.J.ability Coverage Forin S`:-a0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cit'77 of Sarita Ana 20 CT111C CEN7ER PT SAiJTA ANA, CA 92701, @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD THE PETERSON GROUP A-2008-305-002 REVIEVVED BY: POLICYHOLDER ... EUNICE OEREDIA (PG 2 OF 9) SP MENESSIMM CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE; 04-11-2015 GROUP: POLICY NUMBER; 9094902-2015 CERTIFICATE Q 3 CERTIFICATE EXPIRE& 04-11-2016 04-11-2015/04-11-2016 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 -This is to certifV that vve- have issued ._a valid Workers' Compensation insurance policy in a form approved by the California 4nGUrance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give. you 10 days advance notice show1d this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such poiicy, h - t��-- lezl Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT 41600 - PETERSON JR. , ALAN M, PRES SEC TRES - EXCLUDED, EMPLr-)YER THE PETERSON GROUP INC. DSA, THE PETERSON GROUP, INC. 18851 BARDEEN AVENUE, SUITE 225 IRVINE CA 92612 PRINTED : 03--17-2015 fIEV.7-2010 THE PETERSON GROUP A-2008-305-002 REVIEWED BY Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyh older, please cal I us at: (866) 467-8730 Agent, please call us at: (866) 467-8730 SERV ICE .TX@THERART FORD .COM ATTALWED- *** PLEASE REVIEW THE CHANGE *** EUNICE HEREDlA (PG 3 OF 9) Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholider, please call us at: (8 66) 467 -8730 Agent, please call us at: (8 6 6) 467 -8730 between 7 A, M, and 7 P.M. CENTRAL TIME The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. SUPERIOR ACCESS INS SRVC INCIPHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Are Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 THE PETERSON GROUP A-2ooe'nosnmzREV�evvEoBY: POUCYNU01BER: rz aaA AA194s THIS ENDORSEMENT IS ATTACHED TO AND MADE PART CJF YOUR POLICY KN RESPONSE TD THE DISCLOSURE REQUIREMENTS OFTHE TERRORISM RISK INSURANCE ACT. PISCLOSURE PURSUANT TO TERRORISM RISPI INSURANCE ACT SCHEDULE Terrorism Premium: ¢a6.00 A. Disclosure QfPremium In accordance with the federal Terrorism Risk Insurance Act, as amended (TRN).waare required to provide you with o notice disclosing the portion o( your pmmium, if mny, attributable to uowanmge for "certified ado of terrorism" underT0A. The portion of your premium attributable 0o such uuv*nmge is shown in the Schedule of this endorsement. B. The following definition is added with respect to the provisions /f this endorsement: 1. A "certified act of terrorism" means an act that is certified by the Secretary of the Trmauury, in accordance with the provisions o[TR|A. to be an act of terrorism under TR|A. The criteria contained in TRUA for a "certified act of terrvhem"include the foHoxxim0: a. The act reemkw in insured |uowea in o»ooms of$5million in the aggpeAmt*, aUribmtab8v10 all types of insurance subject toTR|A;and b The act results in damage within the United 8betem, or outside the United States in the nnso of certain air carriers or vessels or the premises ofmm United States mission; and o. The not is m violent act or an act that is dangerous to human 8fe, property or infrastructure and is committed by on individual or individuals ao part cf an effort to coerce the civilian popmlmfion of the Form SS 83 76 01 15 United States or to influence the policy affect the conduct of the United States Government byouandon C. Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for o portion of insured looeeo, as indicated in the table ba|ow, attributable to "certified acts oftvrrohmm°under TR|A that exceeds the mppIioob|e insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 2018 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses under TRi4 exceed $100 billion in a calendar year, the Treasury shall not make any payment for any por6on of the amount of such Vonaea that exceeds $100 Wien. The United States government has not charged any premium for (heir participation in covering terrorism losses. @2015' The Hartford (�cludes copyrighted material of the Insurance Services Office, Inc., with its permission.) S�� THE PETERSON GROUP A-2008-305-002 REVIEWED BY `Ae' EUNICE HEREDIA (PG 5 OF 9) D. Cap On Insurer Liability for Terrorism Losses If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIG exceed $100 billion in a calendar year and we have met, or will meet, our insurer deductible under TRIG, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based an its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates, E. Application of Other Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or omission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form, Coverage Part or Policy. F. All other terms and conditions remain the same. Form SS 83 76 01 15 Page 2 of 2 THE PETERSON GROUP A-2008-305-002 REVIEWED BY: EUNICE HEREDIA (PG 6 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 72 SBA AA1945 DX Named Insured and Mailing Address; THE PETERSON GROUP, INC, 18851 BARDEEN AVE # 225 IRVINE CA 92612 Policy Change Effective Date-. 01/29/15 Policy Change Number: 001 gent Name: SUPERIOR ACCESS INS SRVC INC/PHS Code: 181840 Effective hour is the same as stated in the Declarations Page of the Policy. POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED ADDITIONAL INSUREDS) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 001 BUILDING 001 SEE FORM IH 12 00 PRO, RATA FACTOR: 1.000 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 12 11 O4 05 T Page 002. (CONTINUED ON NEXT PAGF) Process Date: 05/07/15 Policy Effective Date: 01/29/15 Policy Expiration Date': 01/29/16 THE PETERSON GROUP A-2008-305-002 REVIEVVFE) BY. EUNICE HEREDIA (PG 7 OF 9) Policy Number: 72 SBA AA1945 Policy Change Number: 001 FORM NUMBERS OF ENDORSEMENTS DELETED AT ENDORSEMENT ISSUE:: SS 50 19 03 12 SS 83 76 03 12 FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - OWNER, LESSEES OR CONTRACTOR FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: ISS 50 19 01 is SS 83 76 01 is Form SS 12 11 04 05 T Page 002 Process Date: 05/07/15 Policy Effective Date: 01/29/15 Policy Expiration Date: 01/29/16 THE PETERSON GROUP A-2008-305-002 REVIEWED BY: EUNICE HERED[A (PG 8 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM SPECIAL PROPERTY COVERAGE FORM STANDARD PROPERTY COVERAGE FORM! UMBRELLA LIABILTY PROVISIONS A Disclosure Of Federal Share Of Terrorism Losses The United States Department of the Treasury will reimburse insurers for a portion of such insured losses, as indicated in the table below that exceeds the applicable insurer deductible: Calendar Year Federal Share of Terrorism Losses 2015 85% 2016 84% 2017 83% 201'8 82% 2019 81% 2020 or later 80% However, if aggregate industry insured losses, attributable to "certified acts of terrorism" under the federal Terrorism Risk Insurance Act, as amended (TRIA), exceed $100 billion in a calendar year, the Treasury shall not make any payment for any portion of the amount of such losses that exceeds $100 billion, The United States government has not charged any premium for their participation in covering terrorism losses. B. Cap On Insurer Liability for Terrorism Losses A "certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in accordance with the provisions of federal Terrorism Risk Insurance Act, to be an act of terrorism under TRIA. The criteria contained in TRIA for a "certified act of terrorism" include the following; 1. The act results in insured losses in excess of $5 million in the aggregate, attributable to all types of insurance Subject to TRIA; and Form SS 50 19 01 15 2. The act results in damage within the United States, or outside the United States in the case of certain air carriers or vessels or the premises of an United States mission; and 3. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an individual or individuals acting as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If aggregate industry insured losses attributable to "certified acts of terrorism" under TRIA exceed $100 billion in a calendar year, and we have met, or will meet, our insurer deductible under TRIA, we shall not be liable for the payment of any portion of the amount of such losses that exceed $100 billion. In such case, your coverage for terrorism losses may be reduced on a pro-rata basis in accordance with procedures established by the Treasury, based on its estimates of aggregate industry losses and our estimate that we will exceed our insurer deductible. In accordance with the Treasury's procedures, amounts paid for losses may be subject to further adjustments based on differences between actual losses and estimates. C. Application Of Exclusions The terms and limitations of any terrorism exclusion, the inapplicability or emission of a terrorism exclusion, or the inclusion of terrorism coverage, do not serve to create coverage for any loss which would otherwise be excluded under this Coverage Form or Policy, such as losses excluded by the Pollution Exclusion, Nuclear Hazard Exclusion and the War And Klitary Action Exclusion. @ 2015, The Hartford (includes copyrighted material of Insurance Services Office, Inc. with its permission) Page I of 1 THE PETERSON GROUP A -2008- 305 -002 REVIEWED BY: POLICY NUMBER: 72 SBA AA1945 EUNICE HEREDIA (PG 9 OF 9) THIS ENDORSEMENT CHANGES THE POLICY. , PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON - ORGANIZATION KSL, KSL LA COSTA RESORT CO, LLC; KSL LA COS'T'A DEVELOLDMENT CORPORATION, AND KSL LA COSTA PARENT, LLC 2100 COSTA DEL MAR ROAD CARLESBAD, CA 92,009 ATTN: CFHEVIS HOSEA, LOC 002 BLDG 001 COUNTY OF LOS ANGELES DEPARTMENT OF PARKS AND RECREATION US ARMY CORPS OF ENGINEERS 823 LEXINGTON- GALLATIN ROAD SOUTH EL MONTE, CA 91733 THE INSURED IS DOING WORK ON A CONTRACT WITH THE CITY STONEWOOD PROPERTIES 3636 BIRCH STREET" STE 180 NEWPORT BEACH, CA 92660 L00001 BLDG001 CITY OF HOPE 1500 E DUARTE RD DUARTE, CA 91010 CITY OF SANTA ANA 2'O CIVIC' CENTER, PLAZA SANTA ANA, CA 92701 XEROX CORPORATION ITS AFFILIATES SUBSIDIARIES' COMPANIES AGENTS EMPLOYEES OFFICERS DIRECTORS ANY APPLICABLE LANDLORD AND ANY APPLICABLE XEROX CLIENT 800 PHILIPS ROAD, MIS 0205/99P WEBSTER, Nil 14580 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Faye 001 Process Date: 11/12/14 Expiration, Date: 01/29/16 a.: