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<br />ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDDNYYY)
<br /> 11/29/2005
<br />PRODUCER (916) 784-9070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br /> ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />AIl-Cal Insurance Agency HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />801 Riverside Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Suite 41105
<br />Roseville CA 95678- INSURERS AFFORDING COVERAGE NAIC#
<br />INSURED INSURER A NONPROFITS INS ALLIANCE
<br />California Hispanic Commission On A INSURER B NORTH AMERICAN ELITE
<br />2101 Capitol Avenue INSURER C
<br /> INSURER 0:
<br />Sacramento CA 95816- INSURER E:
<br />
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
<br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
<br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADD'L.
<br />L. TR INSRD lYPE OF INSURANCE
<br />A X ~ERAL. L.1ABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />1 CLAIMS MADE 0 OCCUR
<br />IMPROPER SEXUAL COND
<br />1,000,000/1,000,000
<br />
<br />COVERAGES
<br />
<br />POL.1CY NUMBER
<br />
<br />POUCY EFFECTIVE POL.1CY EXPIRATION
<br />DATE (MM/DDNY) DATE (MMIDDNY)
<br />11/18/2005 11/18/2006
<br />
<br />EACH OCCURRENCE
<br />~~~~~~J9E~~~~Jence\
<br />
<br />2005-03026
<br />
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<br />
<br />A
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<br />~'LAGGR~E L.1MIT A~ES PER
<br />I X I POLICY I I ~~8T I I LOC
<br />X ~TOMOBILE UABIUTY
<br />_ ANY AUTO
<br />_ ALL O'v\'NED AUTOS
<br />..!. SCHEDULED AUTOS
<br />~ HIRED AUTOS
<br />..!. NON-OVIINED AUTOS
<br />
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<br />
<br />/
<br />
<br />/
<br />
<br />2005-03026
<br />
<br />/ / / /
<br />11/18/2005 11/18/2006
<br />
<br />/
<br />
<br />/
<br />
<br />B
<br />
<br />COMP DED - $250
<br />COLLISION OED -
<br />GARAGE LIABILITY
<br />~ ANY AUTO
<br />
<br />~ESS'UMBRELLA LIABILITY
<br />-.-J OCCUR D CLAIMS MADE
<br />
<br />I DEDUCTIBLE
<br />I ~ETENTION $
<br />WORKERS COMPENSATION AND
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS below
<br />OTHER EMPLOYEE DISHONESTY
<br />FORGERY/ALTERATION
<br />
<br />CWB 000 2271 03 03026
<br />
<br />11/18/2005
<br />/ /
<br />/ /
<br />
<br />$500
<br />
<br />/
<br />
<br />/
<br />
<br />,----
<br />/ /
<br />
<br />/
<br />
<br />/
<br />
<br />/
<br />
<br />/
<br />
<br />,
<br />,
<br />,
<br />PRODUCTS - COMP/OP AGG $
<br />
<br />MEO EXP (Anyone person)
<br />
<br />PERSONAL & ADV INJURY
<br />
<br />GENERAL AGGREGATE
<br />
<br />PROFESSIONAL LIAS.
<br />
<br />COMBINED SINGLE LIMIT
<br />(Eaaccident)
<br />
<br />BOOll Y INJURY
<br />{Per person)
<br />
<br />BODilY INJURY
<br />(Per accident)
<br />
<br />PROPERTY DAMAGE
<br />(Peraccidenl)
<br />
<br />AUTO ONLY - EA ACCIDENT $
<br />
<br />OTHER THAN
<br />AUTO ONLY:
<br />
<br />,
<br />,
<br />,
<br />,
<br />,
<br />I T~~~ItJH-s I I Ol~.
<br />
<br />EACH OCCURRENCE
<br />
<br />AGGREGATE
<br />
<br />E.L EACH ACCIDENT
<br />
<br />E.L DISEASE ~ EA EMPLOYEE $
<br />E.L DISEASE - POLlCY liMIT $
<br />LIMITS
<br />
<br />DEDUCTIBLES
<br />
<br />LIMITS
<br />
<br />$
<br />
<br />1,000,000
<br />50,000
<br />5,000
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />1,000,000
<br />
<br />/
<br />
<br />/
<br />
<br />,
<br />
<br />,
<br />
<br />1,000,000
<br />
<br />/
<br />
<br />/
<br />
<br />,
<br />
<br />,
<br />
<br />,
<br />
<br />EAACC $
<br />AGG $
<br />
<br />,
<br />
<br />100,000
<br />500
<br />
<br />DESCRIPTION OF OPERATIONSILOCATlONSNEHIClESJEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
<br />THE CITY OF SANTA ANA, ITS OFFICERS, AGENTS, OFFICIALS, EMPLOYEES, AND VOLUNTEERS ARE NAMED ADDITIONAL INSURED AS A
<br />FUNDING SOURCE REGARDING THE OPERATIONS OF THE INSURED UNDER THIS AGREEMENT. FORM CG 2026 APPLIES.
<br />
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<br />
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<br />
<br />CERTIFICATE HOLDER
<br />(714) 565-2621
<br />FRAN JUTZI
<br />
<br />(714) 835-7330
<br />
<br />*10 DAYS FOR NON-PAYMENT OF PREMIUM
<br />CANCELLATION
<br />
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ~~X}t<< MAIL
<br />30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, t!~
<br />~~A\1llMlIil<wtlillMllX_Ml(~iIUlll:Kl(~~l[(lOIAi)()MlI)fllE
<br />)OIMlIi~lIX~liMllX__~KK
<br />AUTHORIZED REPRESENTATIVE
<br />
<br />CITY OF SANTA ANA
<br />20 CIVIC CENTER PLAZA
<br />PO BOX 1988 M-73
<br />SANTA ANA
<br />ACORD 25 (2001/08)
<br />ftThl~ INS025 (0108).05
<br />
<br />CA
<br />
<br />92701-
<br />
<br />ELECTRONIC LASER FORMS, INC. - {BOO)327 -0545
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<br />11/18/2006
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<br />
<br />ORD CORPORATION 1988
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