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<br />ACORD_
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br />OP ID V DATE (MMJDD/YYYY)
<br />GRAPH-1 02/23 06
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
<br />
<br />PRODUCER
<br />
<br />Cavignac & Associates
<br />450 B street, suite 1800
<br />San Diego CA 92101-3547
<br />Phone: 619-234-6848 Fax: 619-234-8601
<br />
<br />, NAIC#
<br />24198
<br />33138
<br />
<br />INSURERS AFFORDING COVERAGE
<br />
<br />INSURED
<br />
<br />INSURER A
<br />INSURER B
<br />INSURER C
<br />INSURER D
<br />
<br />Peerless Insurance ~ompany
<br />Landmark American Insurance Co
<br />
<br />Graphic Solutions, Ltd.
<br />dba Fabrication Arts
<br />2952 Main street
<br />San Diego CA 92113
<br />
<br />COVERAGES
<br />
<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 />
<br />l~~~ .~Ds~5 TYPE OF INSURANCE I POLICY NUMBER I ~~~YJ~rDEg~t;;E . ~k~CE\~~b'bt~~,?N I LIMITS
<br />
<br />I~ISURI;;R ~
<br />
<br />GDJCRAL AGCRCGATC
<br />
<br />$1,000,000
<br />$ 100,000
<br />$ 5,000
<br />$1,000,9.09_
<br />$ 2, ~O~_, 000
<br />$ 2,000,000_ ___
<br />1,000,000
<br />
<br />COMBINED SINGLE
<br />
<br />I 01/08/06
<br />LI~IT I
<br />
<br />01/08/07
<br />
<br />I EACH OCCURRENCE
<br />DAlVlp.,", I ""_'" "'....
<br />_PREMISES (Ea occurence)__
<br />~~(A_nyonepersofl)
<br />PERSONAL & ADV INJURY
<br />
<br />A
<br />
<br />GENERAL LIABILITY
<br />X -~I. C.O..MMERCIAL GENE~..AL L. lABILITY
<br />__.. .. _ CLAIMS MADE !Xl OCCUR
<br />X ;Broad Form !
<br />~ Co~-tractual. Liab--
<br />
<br />CBP9557423
<br />
<br />, ~'L AGGR~GATE LIMIT APPLIES PER
<br /> POLICY , m~;: X LOC
<br /> AUTOMOBILE LIABILITY
<br /> ~..-
<br />A 1 AN"UTO CBP9557423
<br /> ALL OWNED AUTOS
<br /> . SCHEDULED AUTOS ,
<br /> X ; HIRED AUTOS
<br /> -I NON OWNED AUTOS -
<br /> GARAGE LIABILITY
<br /> I ANY AUTO ,
<br /> EXCESS/UMBRELLA LIABILITY
<br /> ~ OCCUR I CLAIMS MADE
<br />I
<br /> OEDUCTlBLE
<br /> : RETENTION ,
<br />i WORKERS COMPENSATION AND
<br /> EMPLOYERS' LIABILITY
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE ,
<br /> OFFICER/MEMBER EXCLUDED?
<br /> If yes, describe ul1der
<br /> SPECIAL PROVISIONS below
<br /> OTHER
<br />
<br />PRODUCTS - COMP/OP AGG
<br />,,;;;;;---
<br />Ben.
<br />
<br />01/08/06 '
<br />
<br />01/08/07
<br />
<br />COMBINEDSI~IGLElIMIT $ ~ 000 000
<br />(E"",d,," fm,-
<br />~p~~~~~~)URY $
<br />
<br />ip~~~Lc~I'~.;'n~rY $
<br />-.
<br />
<br />,
<br />
<br />PROPERTY DAMAGE "
<br />(Po,,.,,,,;donl)
<br />AUTO ONLY - EA ACCIDENT ,
<br />OTHER THAN EAACC ,
<br />AUTO ONLY ,11,(;(; $
<br />_E~C~ OCCURRENCE ,
<br />AGGREGATE "
<br /> " ---
<br /> ,
<br />- -.
<br /> ,
<br /> ~ ~-
<br />E.L. EACH ACCIDENT ,
<br />E L DISEASE - EAEMPLOYE ,
<br />E.L DISEASE. POLICY LIMIT ,
<br />
<br />/c'( . .
<br />(! ,>/V c-!;ll, III
<br />I
<br />
<br />A Professional Liab
<br />Claims Made
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
<br />Re: Main Street Archway signage. The City of Santa Ana, its officers,
<br />agents, representatives, volunteers and employees are named as additional
<br />insureds primary as respects general liability per GECG602 09/04 and policy
<br />form (primary verbiage from policy attached). Per Project Aggregate applies
<br />as respects general liability per CG2503 03/97 (endorsement will be [cant.]
<br />
<br />LHR803694
<br />
<br />02/04/06 !
<br />.
<br />
<br />02/04/07
<br />
<br />Ea Claim
<br />Aad'red'ate
<br />
<br />1,000,000
<br />1,000,000
<br />
<br />CERTIFICATE HOLDER CANCELLATION
<br />
<br />City of Santa Ana
<br />Attn: souri Amirani
<br />20 civic Cntr Plaza, 4th Floor
<br />Santa Ana CA 92701
<br />
<br />SANTA-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE THE EXPIRATION
<br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
<br />NOTICE TO THE CERTlI"ICATE HOLDER NAMED TO THE LEFT. BUT I"AILURE TO DO SO SHALL
<br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR
<br />
<br />AGORD 25 (2001108)
<br />
<br />
<br />(g) Al:OKU GUK"'Ut<A IIUN 1~8ts
<br />
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