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J CERTIFICATE OF LIABILITY INSURANCE OP ID DB DATE(MM/DD/YYYY) <br />PRODUCERHENNE-J 07/23/09 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />Crosby Insurance, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />8181 E. Kaiser Blvd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV <br />Anaheim CA 92808 <br />Phone: 714-221-5200 Fax: 714-221-5210 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED J / <br />INSURER A: Golden Eagle Ins Corporation <br />•/� INSURER B: <br />Hennesse& Hennessey LLC INSURER C: <br />17300 17h Street, J-251 <br />Tustin CA 92780 NsuRERD <br />/p <br />�V1 INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR INSR TYPE OF INSURANCE POLICY NUMRFR POLICY EFFECTIVE POLICY EXPIRATION <br />FE <br />LITY <br />A IALGENERALLIABILITY CBP9595827 <br />S MADE 7 OCCUR <br />VJUJE <br />EGATE LIMIT APPLIES PER. <br />PRO- <br />JECT LOC <br />LIABILITY <br />ONED AUTOS <br />LED AUTOS <br />AUTOS CBP9595827 <br />NED AUTOS <br />GARAGE LIABILITY <br />—1 ANY AUTO <br />EXCESS/ UMBRELLA LIABILITY <br />A X OCCUR ❑ CLAIMS MADE CU 8374163 <br />DEDUCTIBLE <br />RETENTION $ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY Y I N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE❑ <br />OFFICERIMEMBER EXCLUDED? <br />(Mandatory In NH) <br />If yes, describe under <br />SPECIAL PROVISIONS below <br />OTHER <br />JE5CRIPTION OF OPERATIONS / <br />SEE ATTACHED <br />E MMIDD/YYYY DATE MM/DD/YYYY LIMITS <br />EACH OCCURRENCE $1,000,000 <br />06/06/09 06/06/10 PRREMISES(Ea oEccuDence) $ 100,000 <br />MED EXP (Any one person) $5,000 <br />PERSONAL & ADV INJURY $ Excluded <br />GENERAL AGGREGATE $2,000,000 <br />PRODUCTS - COMP/OP AGG I $ 2 , 000 , 000 <br />06/06/09 <br />06/06/09 <br />APPROVED AS TO FORM <br />Laura SuLt Sh °edy <br />'/ EXCLUSIONS <br />06/06/10 <br />COMBINED SINGLE LIMIT $ 1 00O O00 <br />(Ea accident) r , <br />BODILY INJURY $ <br />(Per person) <br />BODILYINJURY <br />(Per accident) $ <br />PROPERTY DAMAGE $ <br />(Per accident) <br />AUTO ONLY - EA ACCIDENT $ <br />OTHER THAN EA ACC $ <br />AUTO ONLY: <br />06/06/10 <br />OCCURREN0,000 <br />TAGGIEACH <br />AGGREGATE0,000 <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYE $ <br />E.L. DISEASE -POLICY LIMIT $ <br />CERTIFICATE HOLDER CANCELLATION <br />j,.t� Zi '7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO <br />y t'v f. �(� �ITYSAN DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL *30 DAYS WRITTEN <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />City of Santa Ana <br />Public Workj 7 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />P.O. BOX 19tftfi' I1, ow REPRESENTATIVES. <br />Santa Ana CA 92702 AUTHORIZED REP ENT E <br />LL <br />aCORD 25 (2009/01) 9 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />