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' A1CbRD RBFCO-1 CERTIFICATE OF LIABILITY INSURANCE OPID (MM07 07 /07/YY4 04 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE United Captive Ins. Brokers HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 17151 Newhope St., Ste 211 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fountain Valley CA 92708 Phone:714-708-4370 Fax:714-708-2300 INSURERS AFFORDING COVERAGE NAIC# ""-- INSURER A: U.S. Fidelity and Guaranty Co. INSURER B: REF Consulting INSURER C. 14725 Alton Parkway INSURER D. Irvine CA 92718 INSURER E IK�$�ia:e�naa 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLI Y EFFECTIVE DATE MM/DDM' POLI Y EXPIRATION DATE MWDD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑ OCCUR PREMISES (Ea ocwrence) $ MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPIOP AGG $ POLICY PRO- ECT LOC AUTOMOBILE LIABILITY ANYAUTO COMBINED LIMIT CO D $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ $ AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY OCCUR CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ AUlm WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE D123W00096 07 Ol /04 07/01/05 X TORV LIMITS ER E L. EACH ACCIDENT $1000000 OFFICFR/MEMBER EXCI.I IDI If yes, descdde under E.L. CISEAS -EA Cz!^LOVCEr$1DODOvD EL.DISEASE - POLICY LIMIT t $ 100000 0 SPECIAL PROVISIONS below OTHER APP OVER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 days notice of cancellation for non-payment of premium. Re: JN 10-102081. Design & Development Standards. Laura Stitt Sheedy Assistant City Attomea i.Mrc I Ir KlA I D nuILLI CANCELLATION City of Santa Ana, Plang. Div Ms. Maya DeRose, Sr. Planner 20 Civic Center Plaza Ross Annex Bldg., 2nd F1. Santa Ana CA 92702 CITYSAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL EMAIL *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD 25 (2001/08) © ACORD CORPOR.