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<br />MMC
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<br />10/16/2008 10:57:02 AM
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<br />Eastern Time Zone
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<br />- - 1_ DATE IMMIDDIVYVYj
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<br />10/15/2008
<br />
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<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 POUCIES BELOW.
<br />
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />
<br /> ,S, AO~~ TYPE OF INSURlNCE ~OUC'f NUNSER r.OllCY EFFeCTIVE 'POLICY eX~flATIONI L.lMITS :.
<br /> i.TR INSR DATE (MM!DDiVV) DATE (MMiOOIYV:
<br /> A X GL1871946 _L_~~~, '~c.; - 1 000 00
<br /> I~M"'":A. ,""RA. .,A,,,,n 09/0 liCe oe/01/09 -TIiifA~,~cI=lENIt:D $ 1,000,00
<br /> PREIiJIISES Ea,'CCJrsnce\
<br /> , ~ CLAIMt> IVIADE TI U.:;r:;I,R MED EXP iAnv ~ne penon) $ 10.00c
<br /> X ~LUnii_ PERSQNo\L & ADV INJURY $ 1,000.OOC
<br /> I __~ Per policv ~ 1 0 000 000 _ I GENE~LAUGRE:G^TE $ 2.000,001
<br /> l'ENE~LA~'~A E LI/oI.ITAPP_,Eloi PER 2,000,00
<br /> II P(}L1CY j~~~ f"Xl L:X PROD' _CTS ':;Or.' ;I10P AG.
<br /> A I X rTOM08lLE LIA81UTY AL 1607793 09/01,'08 09/01/09 i -:;OM81""m SII\03~E LIMIT
<br /> X I AI\YAUT'I i:[SO<:c.;lGn': $ 1.000.00C
<br /> AL."W'lFC:A'JT("1~ I ! BO)ILYI'l.JIJRY $
<br /> ! =~ SCHED,JLE) AI Tn::. iiP<Yplrs",n!
<br /> ; X ! '-l1j:;EO AUT:)S I i
<br /> \ ~, , SO)CI,Y ;I\jJIIR~ $
<br /> :X I NOr....)WNEJ AIJ1US ;P'i< A.,~~d<lml
<br /> -
<br /> X ,Comp $1 ,000 Ded PROPE rnv DAMA3E '$
<br /> iX"1 Coli It 1 000 Oed IPer a~d,jem:
<br /> ! GARAGE UAB1LITV AIJTOUNlY EAACO::IDE\lTi$
<br /> ~AIliYAI;Tn : :)THEI'<T'-IA1Ii ::AAC'~ $
<br /> , ! AUTO Ol\~Y AGG $
<br /> ~ESSU"BRELlA U'''UTV BE6081872 i 09f01/08 I EACH '-)O;ljRREIliCE $ 5.000.00
<br /> B X-J ,,,;,;Ui\ :J CAlM::. 'v\Il..OF 09101/09
<br /> I , I A(;'::;REGATE $ 5,000.00
<br /> I I $
<br /> :JEJUCII:U:; !
<br /> X RFTFIliTICI\. S $
<br /> A WORKERS COMPENSATION AND WC4800627 (ADS) 09/01/08 09/01109 X I..WCSTATU~1 IOJ~-
<br /> EMPLOYERS' UABILlTY
<br /> A ANY PI-<C'PMIE"';'.-JK'PARTIliFR:EXF'~1 TIVE WC4800628 (CA) 09fOl/08 09/01/09 LEACH ACCI:JENT .$ 1,000,00
<br /> OFF,;ERI'-'EMBER EX;.I~Cl[D7 E L. DISEASF. EAEMPl(lVEEl$ , ,000,00
<br /> ItV%,descnbeJ1jet L [i 5:::ASE . :>"lICY LIMIT 1$
<br /> , SPECIAL P"OVISln\lS ""c'W ' .000,00
<br /> OTHER
<br />: , I
<br />I I
<br /> DESCRIPTION OF OPERATlONSILOCATIONSlYEHICLESIEXCWSIONS ADOEO BY ENDORSEMENT/SPECiAl PROVISIONS
<br /> Re: Site .#LA.0623B/M'.Idison Park 1528 S Standard Aile., Santa Ana. CA 92707
<br /> Where required bV wntten contract Ce-rtificate Holder is an ~dditio.nallnsured (except on Walkers' Camp) as respec1s operations of the Named Insured.
<br /> Where requITed by Written cOrttract, tne above referenced pohcy(s) Includes Waiver of Subrogation In lavor of the Certificate Hdder
<br />~ -
<br />
<br />ACORD~
<br />
<br />PROOUCER
<br />Marsh USA. Inc.
<br />4400 CommerIC:a Bank Tower
<br />1717 Main 5t.
<br />Dallas, TX 75201-7357
<br />Artn: dallas.ceris@marsh.com
<br />063165..AlI-08-09 LA
<br />
<br />Fax. 212-948-0519
<br />06238 5M
<br />
<br />INSURED
<br />
<br />Royal Street Communications, LLC A~ ;)007~ J-Dt
<br />2435 North Central Expressway, #1200
<br />R;chardsoo. TX 75080 A- d- 007 - 0'+3
<br />
<br />
<br />A.ucq-o4:>-
<br />
<br />INSUR ERS AFFORDING COVERAGE
<br />INSURER A Insurance Company Of The State 01 PA
<br />INSURER B National Union Rre Ins Co Pittsburgh PA
<br />INSURE",';
<br />
<br />I NAIC#
<br />19429
<br />19445
<br />
<br />J
<br />
<br />+
<br />
<br />INSIJ:<ERO
<br />I NSJRER:;
<br />
<br />CERTIFICATE HOLDER
<br />
<br />HOU-OOOS38125-09
<br />
<br />CANCELLATION
<br />
<br />ACOR02~(2D011Oi) ,-------;--
<br />
<br />4~:~~~'::>
<br />
<br />i{LO'> I C, t.y /';fjrrrf1 <-'-j / C ! ,iJ/e, '0
<br />
<br />City of Santa Ana
<br />Attn~ Carla Tnompkir.s - Parks, Rec. & Community Services
<br />(M-23)
<br />l::xecutive Director
<br />eBe W Santa An~
<br />Santa Ana, CA 927{)2
<br />
<br />Fax frOM
<br />
<br />SHOULD MolV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION D"TE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />3JL__OlVSWRITTEN NOTiCE TO THE CERTIFICATE HOlDER NAMEO TO 'THE LEFT,
<br />BUT FAlUJRE TO 00 SO SHALL-IMPOSE NO OBLIGATION OR L.IABllITY OF ANY KINO
<br />UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />~~~~~~l.n~:SEMUnYE IA./~ 1/ ....,1~~
<br />William Hines
<br />
<br />a ACORD CORPORATION 1988
<br />
<br />111/1&/116
<br />
<br />117:57
<br />
<br />h' 3
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