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DATE 5;a""'AI CERTIFICATE OF LIABILITY INSURANCE ;zoa THIS CERTIFICATE IS ISSUED AS A MATTEROFINFORMATION 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(les) 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 andorsoment s PRanu0Eee - NMEc Girds Delstrom _. Assurance Agency, Ltd. 847 .403 7218 — 8p.a 4460128. OneCentUr PHONE Centre _flfc.Ne&X36�,.-.), y EMAIL 9750 E. Golf Road ppuBAsS uialStrom_*sssura Schaumburg IL 60173"--.INSUR? 5APPORDINeCOVERAOE AICq ..._ .-.._...,...__..-....._:._ _.....__�.:... ..._..��........,._ INSUaERA• Protective Insurance Company r 12416 INSURED INSURER R • - Personnel Staffing Group, LLC -_.._ .�.._._., __.,.......,m,.„. dba KBS Staf ng INSURER C: 1751 Lake Cook Road, Suite 600 Deergeld IL 60015 n1,su E SaRF COVERAGES CERTIFICATE NUMBER: £780433911.. 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 CONUTTIONS OF SUCH POLICIES. LIMITS SHOWN MAY. HAVE BEEN. REDUCED BY PAID CLAIMS. 11 SR _. _..-_...._,.—""iAtlDL sdaw ...... _ _:._:.... .....__,._._ POLICY EFF... gL1OPt:1(P ........_,...,,_......_.-.-.... ... ............. ... LTR TYPE OF INSURANCE - g1 P I Y aER MIa lab Y... LIMITS GENERAL LIABILITY EACH OCCURRENCE - S COMMLRCIAL GLNFRAI, LIABILITY PRMAGET(i'R'ENTED $ lwMASES.(GP.astupsmtml._. _... _. ,. � CLAIMS—MADE . , OCCUR MEO EXPAAnyane pezon) PERSONAL&AOVINJUR) $ m. _.._ OENERALAGCRECATE $ _..—_G.L.NLI'CAGlIGCYREGATE LIMIR AIV�UES PLR - PROOMFX)CTS-COMPOPA(X3 r — . _.—.W: $$ ,_._ CCr .. a ...._. __..,IAUTOMOnO.ELIABILITY111INGUE.71" A4�on..�..... �.._ ANYA1110 cal INJURY(Psrpamon) $ ALL OWNED SCHEDULED- � AUTOS AUTOS UODILY INJIJRV IPornaltlonp $ •.. ...NUN-OwNEOTR'.L1ATA"",......, $.. -,. HIRED ATTICS AN Oa rAmg UMBRELLA LIAO OCCUR CACTI OCOIJRRFNO $--- EXCESS LIAR CLAIMS -MADE ACGRCGATE IS DED 9 RETENTI' N - $ A IN RKERS COMPENSATION RW0000a1 Ci13D12o, SftOl2010 X1 VC ST TU rITH.. - - A AND EMPLOYERS' LIABILITY YIN M=488 613012017 "0/2010 ,. TQRY_UMITS, ANY PRCPRII Y URIPAR'YNERIEXECU'TIVE LL EA HACCIDENr $1000400 OFFICERINIF HFR P.R4:LIlUED9 N I A manaaroa In NH) E I VISLASF PA EMPLOYEE Y t�011tl tlD0 Ir Yea deenriboundor -. ama DLS4IIP1'ION Of OPERATIONS below i E,L DISEASE POLICY $1.0]0000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ADDED 101, A0dldonel Renculm Schedule, If more apace Is mqulmd) Proof of insurance RE: Employees assigned by All City Management Services dba The Crossing Guard Company 10440 Pioneer Blvd Suite 5, Santa Fe Springs CA 90670 A Waiver of Subrogation in favor of the Certificate Holder applies to the Worker's Compensatlon policy only, when required by written contract and where allowed by law. -EH—R—rtFl CANCELLATION ._GATE HOLDER' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana 60 Civic Center Plaza Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE �.� RJ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD / v c;YIlLI J�