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�'► �"� CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMlDDIYYYY)
<br />02/02/2011
<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 ADDI: I N Eq;"ih4 r-ooPi�y�ies) 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 1- -¢994-,7100.
<br />'CONTACT
<br />Arthur J. Gallagher Risk Management Serve ,'"Inc.
<br />^.J i_
<br />PH NE FAX
<br />AIC No):
<br />N E(AIC,
<br />E-MAIL
<br />ADDRESS:
<br />444 Madison Avenue
<br />PRODUCER
<br />CUSTOMER 1
<br />20th Floor
<br />New York, NY 10022
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A: INSURANCE CO OF THE STATE OF PA 19429
<br />INSURER B: NATIONAL UNION FIRE INS CO OF PITTS 19445
<br />Greyhound Lines, Inc.
<br />INSURERC: ILLINOIS NATL INS CO 23817
<br />350 N. St. Paul St.
<br />INSURER D: NEW HAMPSHIRE INS CO 23841
<br />Dallas, TX 75201
<br />D -
<br />INSURER E:
<br />INSURER F:
<br />COVERAGES CERTIFICATE NUMBER: 19618198 REVISION NUMBER:
<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 />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADSL SUBRPOLICY EXP
<br />POLICY NUMBER MM/DDY EFF MM DD//YYYY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X
<br />GL0949389
<br />12/31/1
<br />12/31/11
<br />EACH OCCURRENCE $ 5,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE a OCCUR
<br />DAMAGE TO RENTED 5,000,000
<br />PREMISES Ea occurrence $
<br />MED EXP (Any one person) $ 50,000
<br />PERSONAL & ADV INJURY $ 5,000,000
<br />GENERAL AGGREGATE $ 10,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG $ 5,000,000
<br />POLICY 7PRO X LOC
<br />$
<br />B
<br />B
<br />C
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />X
<br />CA0949249 (VA)
<br />CA0949247(AOS)
<br />CA0949248(TX)
<br />12/31/1
<br />12/31/1
<br />12/31/1
<br />12/31/11
<br />12/31/11
<br />12/31/11
<br />COMBINED SINGLE LIMIT $ 5,000,000
<br />(Ea accident)
<br />BODILY INJURY (Per person) $
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident) $
<br />X
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />APPROVED AS ''
<br />o , o R
<br />m
<br />PROPERTY DAMAGE $
<br />(Per accident)
<br />$
<br />X
<br />NON -OWNED AUTOS
<br />$
<br />UMBRELLA LIAB
<br />EACH OCCURRENCE $
<br />ZeC)_}%
<br />AGGREGATE $
<br />HOCCUR
<br />EXCESSLIAB
<br />CLAIMS -MADE
<br />Laura St;tt
<br />DEDUCTIBLE
<br />$
<br />.ASSIStanT. City Attornel.
<br />$
<br />RETENTION $
<br />D
<br />D
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />N / A
<br />WC1705104,WC1705100
<br />WC1705101 & 1705095
<br />WC1705102,WC1705103,1705
<br />12/31/1
<br />12/31/1
<br />9$2/31/1
<br />12/31/11
<br />12/31/11
<br />12/31/11
<br />X WCSTATT- OTH-
<br />E.L. EACH ACCIDENT $ 5,000,000
<br />E.L. DISEASE - EA EMPLOYEE $ 5,000,000
<br />D
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />WC1705096, WC1705097
<br />12/31/1E.L.
<br />12/31/11
<br />DISEASE -POLICY LIMIT $ 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />Re: leased location - The Depot at Santa Ana; 1000 East Santa Ana Boulevard, Santa Ana CA. Landlord, Its agents,
<br />officers, employees and volunteers are included as Additional Insured as per insured contract subject to policy terms,
<br />conditions and exclusions. Coverage is on a primary/non-contributory basis as evidenced herein as required by written
<br />contract.
<br />City of Santa Ana
<br />c/o Public Works Agency/SARTC
<br />20 Civic Center Plaza (M-21)
<br />Santa Ana, CA 92702-1988
<br />tanstep
<br />ACORD 25 (2009/09)
<br />19618198
<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 />USA I
<br />C 1988-2009 ACORD CORPORATION. All rights reserved.
<br />The ACORD name and logo are registered marks of ACORD
<br />
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