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.; ~ ~ .. <br />f ~ ` ' ~r <br />~~ <br />ACORDTM CERTIFICATE OF LIABILITY INSURANCE alan0099Y24:39AM <br />PRODUCER 68777 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION <br />AON RISK SERVICES CENTRAL, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />CHICAGO IL OFFICE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />200 E. RANDOLPH STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />CHICAGO IL 60601 <br /> <br /> INSURERS AFFORDING COVERAGE NAiC # <br />INSURED 1014 INSURER A: New Hampshire Ins. Co. <br />TIME WARNER NY CABLE LLC INSURER B: Ins. Co. State o[ Pennsylvania <br />DBA TIME WARNER CABLE <br />CONTINENTAL BLVD., SUITE 250 <br />550 N <br />INSURER C: State of Washington Repl of Labor & Ind. <br />. <br />Et SEGUNDO CA 90245 INSURER D: Sl. Paul Fire & Marine Ins. Co. <br /> INSURER E: Ohio Bureau of Workers' Compensation <br />(:VVtKRCitJ <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED) NAMED A80VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />HICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W <br />EXCLUSIONS AND CONDITIONS OF SUCH <br />HEREIN IS SUBJECT TO ALL THE TERMS <br />. <br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED <br />MAY PERTAIN <br />, <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ' POLICY EFFECTIVE POLICY E%PIRATION LIMITS <br />INSR <br />LTR I Aoo <br />L <br />N6R TYPE OF INSURANCE POLICY NUMBER DATE (MMlDOIYY) GATE {MMIDOIYY) <br />A GENERAL LIABILITY 6506223 1/1/2009 1/1!2010 EACriocCUaRENCE $ 3,000,000 <br /> DAMAGE TO RENTED 1 <br />000 <br />000 <br />~ <br /> COMMERCUIL GENERAL LIABILITY PREMISES Ea occurrence , <br />, <br />. <br /> X AIMS IAADE OCCUR 1dED EXP (Any one person) $ 10,000 <br /> CL PERSONAL d ADV INJURY $ 3,000,000 <br /> GENERAL AGGREGATE § 6,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER'. PRODUCTS ~ COMPlOP AGG 5 S.000,OOO <br /> <br /> X POLICY ROJEC7 LOC <br />A AUTOMOBILE 11A81LITY NIA - 6506064 1/1/2009 111/2010 OMeINED SINGLE LIMIT <br />$ 5,000,000 <br /> 6508083 <br />Es ecadent) <br /> X NY AUTO VA - <br />6506082 <br />AOS BODILY INJURY <br /> LL OWNED AUTOS - (Per person) $ <br /> CHEDULED AUTOS <br />A <br />~ <br />!~pp // ~~ Y~ <br />~ <br />' <br />BODILY INJURY <br /> HIRED AOTOS APPR , <br />V1-J~ t1~ lY <br />l./ ~lJh /Par sccidenl) S <br /> <br /> NON ~OW NED AUTOS PROPERTY DAMAGE <br /> t ~ ~ > (Per eccidenq $ <br /> C l~ <br /> GARAGE LIABILITY ~ " <br />~ AUTO ONLY-EAACCIOENT $ <br /> LiIU[d ~I:L; SI Ct <br />y EA ACC <br /> ANYAUTO <br />' OTHER THAN $ <br /> ~f y <br />SLSt1[Tl ~.JL L[OStIOV AUTO ONLY - <br /> , AGG $ <br />D E%CESSIUMBREILA LIABILITY QK01201974 111!2009 1/112010 EACH OCCURRENCE $ 25,000,000 <br /> X OCCUR ^CLAIMSMADE AGGREGATE. $ 25.000,000 <br /> DEDUCTIBLE § <br /> RETENTION S <br />/~ WORKERS COMPENSATION 7X-5455930, FL-5455932 1/1f2009 1/1!2010 X T Y <br /> ANO EMPLOYERS' LIABILITY <br />E CA - 8731087, AOS - 5455927 E.L. EACIi ACCIDENT $ 2,000,000 <br /> ANY PRDPNIETORrPARTNERIEXECUTIV ND,OH,WA,WY - 5455931(EL only) <br />DISEASE - EA EMPLOYEE <br />E <br />L <br />$ 2 <br />000 <br />000 <br />B OFFICERIMEMBER E%ClU0ED7 Vy) _ 5455931 (Slat. 6 EL) . <br />. , <br />, <br /> If yos describe under OR - 5455928, MA - 5455929 <br />E.L DISEASE • POLICY LIMIT <br />$ 2,000,000 <br /> SPECIAL PROVISIONS Celow <br /> <br />E OTHER <br />Ohio W/C <br />20004115 <br />12/1/2008 <br />12!1/2009 <br />S <br />C Monopatistic-WA W!C 826986-12 6/1/2008 6/112009 <br /> W omin (Stale of WY) 003627561 7!3112008 7/3112009 <br />DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES / EXClUS10NS ADDED BY ENDORSEMENT 1 SPEC)AL PROVISIONS <br />THE CITY OF SANTA ANA. ITS OFFICERS. EMPLOYEES. AGENTS, AND VOLUNTEERS APE INCLUDED AS ADORIONAL INSURED ON THE APPLICABLE lU1BIlrrY COVERAGES (E%CEPT ON TILE <br />THE OPERATIONS OF THE INSURED AND SUBJECT TO THE RESPECTIVE INSURANCE <br />YdORK[RS COMPENSATION POLICY) AS REpUIRED BUT THE ADDITIONAL INSURED STATUS IS LIMITED TO <br />POLICY TERMS. CONDITIONS AND LXCLUSIONS <br />~ ---- <br />reurcl 1 ennu <br />I.LRllrrl.M lC nr-/~ucR -' --- <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELlEO BEFORE THE EXPIRATION <br />- <br /> <br />CITY OF SANTA ANA TEN <br />DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRn <br />TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FNLURE TO DO SO SNALL <br />NOTICE <br />CTV3, PARKS & RECREATION DEPARTMENT . <br />IIdPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />ATTN: KATHY SOWERS REPRESENTATIVES. <br />SANTA ANA BLVD., 2ND fLOOR <br />888 W <br />. <br />SANTA ANA CA 92702 AUTHORIZED REPRESENTATIVE <br /> <br />ACORD 25 (2001108) ®ACORO CORPORATION 1988 <br />