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906C 15tf
<br />DATE (MM/DD/YYYY)
<br />CERTIFICATE OF LIABILITY INSURANCE 7/5/2011
<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 SUBROGATION IS WAIVED, 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 />CONTACT
<br />NAME: Trish Kusal
<br />PHONE (816)224-6100 ac Ne_(B18)224-6099
<br />C. M. M"1e,rH Company, Inc.
<br />-MAIL _ TGr@an.@ ®ma L- . com
<br />21045 Ca1i£a St. #100AD
<br />PRODUCER .0027846
<br />INSURER(S) AFFORDING COVERAGE NAICe
<br />Woodland Hilla CA 91367
<br />INSURED
<br />INSURERAHart£ord Casualty I-SU=a,n C" CO
<br />A
<br />INSURER B Hart£Ord Fire, Inauranca Co.
<br />LaBe,lle, Marvin, Ina. -
<br />INSURER—U.S. Spe,Cialty Ins CO
<br />2700 So. Grand Ave,
<br />INSURER D:
<br />INSURER E:
<br />PIR E Ee ocr�artence S 300,000
<br />INSURER F:
<br />Santa Ana CA 92705
<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 />tLTR
<br />TYPE OF INSURANCE
<br />JNDKPOLICY
<br />a.
<br />NUMBER
<br />POLICY EFF
<br />IPOLICYDEXP
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE S 1,000,000
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE � OCCUR
<br />X
<br />23BANo6283
<br />6/16/2011
<br />/16/2012
<br />PIR E Ee ocr�artence S 300,000
<br />MED EXP An one rson) S 10,00
<br />PERSONAL 8 ADV INJURY $ 1 , 000 , 000
<br />GENERAL AGGREGATE E 2 , 000 , 000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG E 2 , 000 , 000',
<br />$
<br />X POLICY PRo- LOC
<br />AUTOMOBILE LIABILITY
<br />JX ANY AUTOALL ONMEO AUTOS
<br />SCHEDULED AUTOS
<br />AUTOS -
<br />72UZCA 0364
<br />wBODILY
<br />APPROVt all A
<br />6/16/2011
<br />TO F
<br />/16/2012
<br />RM
<br />COMBINED SINGLE LIMIT
<br />(Ea BINent) S 1,000,000
<br />ODILY INJURY (Per perccson) S
<br />INJURY (Per aident) S
<br />PROPERTY DAMAGEHIRED
<br />(ParacnJdent)
<br />Ddt other car S
<br />NON-O-NED AUTOS
<br />�' �
<br />7
<br />Uninsured motorist combined S 1,000,000
<br />X UMBRELLA LIAR
<br />X
<br />OCCUR
<br />aura `
<br />CC Y
<br />EACH OCCURRENCE S 5 , 000 ,060
<br />EXCESS LIAR
<br />.0 'CC,
<br />'df]SISLa❑L
<br />Attorney
<br />AGGREGATE E 5,000,000
<br />DEDUCTIBLE
<br />S
<br />A
<br />X RETENTION S 1D 000
<br />723HANt16283
<br />6/16/2011
<br />6/16/2012
<br />E
<br />B
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' UASI TY Y / N
<br />ANY PROPRIETOWPARTNER/FJ(ECUTIVE
<br />X WC STATU- OTH-
<br />E.L. EACH ACCIDENT E 1.000.000
<br />OFFICER/MEMBER EXCLUDED'!
<br />(Mandatory In NH)
<br />12WECRQ5643
<br />6/16/2011
<br />6/16/2012
<br />E.L. DISEASE - EA EMPLOYE E 1 000 000
<br />It YYee Oeauibe untler
<br />DESGrRIPTION OF OPERATIONS below
<br />E -L. DISEASE - POLICY LIMIT E 1 000 000
<br />C
<br />Pro££aaional Liability
<br />331020500
<br />6/16/201.1
<br />6/16/2012
<br />1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach AGORD '101, Addltbnal Ramarlu Schadula, K mora apace Ia rpulred)
<br />City of Santa Ana is included as Additional SDaured per tesla Buainasaa LiabiliCy Coverage :E.— 330008 and a General
<br />Liability waiver or Subrogation applies Eo Che cert/Zicate holder par Zorn 330008.
<br />mbooth"@aanta-ana. org
<br />City o£ Santa Ana
<br />A. t.
<br />Marilyn Booth"
<br />20 Civic CeInte,r Plaza (M-36)
<br />Santa Ana, CA 92702
<br />ACORD 25 (2009/09)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />® 1988-2009 ACORD CORPORATION_ All rights reserve
<br />rn 502s (200909> I ne rla.vlcu name ana logo aro reglaL — marRe — MLVRU
<br />
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