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<br />ACORD CERTIFICATE OF LIABILITY INSURANCE ! DATE (MMJDDNYYY) <br />TM. 0510612OO8 <br />PRODUCER Phone: (800) 395-8075 Fox: (858) 519.fl822 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />FITNESSAND~NESS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />380 STEVENS AVENUE, SUITE 206 HOLDER. lHIS CERTIFICATE DOES NOT AMEND, EXTBlD OR <br />SOLANA BEACH CA 92075 ALTER THECOVERAGE AFFORDED BY THePOUCIES BELOW. <br /> , <br />/v/ 2007-/3 b I INSURERS AFFORDING COVERAGE NAIC# <br />.... .---....--.--......- AQIlncy UeI: 03n645 : .~.._-_.._..." <br />INSURED ilNSURER A: F'~I~~&llp~ia II!~_n~ Insurance CompanY-.__~_....._.___._ <br />Virginia Mlsclone :INS~RER B: - -.-..... ....- <br />700 E. Lake Drive [INSURER c: <br />Unit 118 ... ...-"-------_.-- --_..--~.-----_........-.....- <br />Orange, CA 92866 INSURER 0: ! <br />------............ <br /> : INSURER E: <br /> <br />COVERAGES <br /> <br />ntE POlICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO ntE INSURED NAMED ABOtIE FOR THE POLICYPERlDD INDICATED, NOlWl1HSTANDING <br />AfoN REQUIREMENT, TERM OR CONDITION OF Nfl CONTRACT OR OTHER DOCUMENT WIlli RESPECT lOWHlCH ntIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AlLlliE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />--=-----.. <br />....:Niin.! .~~~;~~N~~u Poua'NUMBER <br />LlR . <br />GENERAL lIABILITY <br />ix COMMERCIAL GENERAL LIABILITY <br />r~ CLAIMS MADEL)(] OCCUR <br /> <br />~-; <br />: GEN'L AGGREGATE LIMIT APPLIES PER: <br />f---o . PRO- j <br />, X : POliCY 'T LOCI <br />I AUTOMOBIlE UABIUTY <br />i........... <br />! : ANY AUTO <br />!. ... j ALLOWNEDAUTOS <br />1-"""'; <br />L-J SCHEDULED AUTOS <br />I : :::::AUTOS <br /> <br />PHPK284105 <br /> <br />POLICY EFnCTIVE <br />DA1'E <br />05/01108 <br /> <br />: POI.It:\' l!llPlRATION ! <br />. DATa ; <br />05101/09 ; EACH OCCURRENCE <br />, ONAAGE TO REHTl!D <br />L~ES(Ea-1 <br />L~s.>..~~~-~-_. <br />: PERSONAL & ADV INJURY <br /> <br />. GENERAl-AGGREGATE <br /> <br />UMITS <br /> <br />PROOUCTS-COMPJOP AGG. <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />j: <br /> <br />-.1,OOO,o..!J~. <br />100,000 <br />__;~~O <br />1,000,000_ <br />_.~..1!OO,oOO <br />_~,.o.o.~1o.00 <br /> <br />A <br /> <br />: BOOL Y INJURY <br />dPer p8ImI'l) <br /> <br />I <br />1$ <br />I.- <br />Is <br />; <br />i <br />i~~~=:.__..__._..1~ <br />1$ <br /> <br /> <br />! COMBINED SINGLE LIMIT <br />. (Eo aceidenl) <br /> <br />~ EXCESS I UMBRELLA UABlLlTY <br />i-I OCCUR [J ClAIMS MADE <br /> <br /> <br />AUTO Q.Nl Y::..EA AC.!lIOENT )$ <br />: OlliER THAN I:AAg: :$ <br />'AUTOONLY: AGG i$ <br />j EACH OCCURRENCE ____..__/!.._..______ <br />,AGGREGATE :$ <br />I. <br />!$ <br />--~.---_.. ........-.---.-.-....!... <br />i$ <br />.._-~--=---------~---_._..__..._--- <br />$ <br />, ~f=TS I OTHER +--________. <br />i.;:~:~;:~~O::LOYEe--~___---.- <br /> <br />: EL DISEASE-POLICY LIMIT Is <br /> <br />. GARAGE LIABILITY <br /> <br />. ANY AUTO <br />U. ...~ <br /> <br />; DEDlICTIBLE <br />RETENllON $ <br /> <br />WORKERS COMPENSATION AND <br />EMPLOYeRS' lIABILITY <br />ANY PRDPRIETORIPARTlIERlEXECUTIVE <br />OFflCERlMEM8ER EIlCI.UOED? <br />If,... dauibe under <br />SPECIAl. PRO\/IS1OllS bel_ <br /> <br />I OTHER: <br />I <br />I <br /> <br />DESCRIPTION OF OPERATfONSJLOCATlONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS <br />The City of Santa Ana. 20 Civic Center Plaza, Santa Ana, CalifornIa; Its officers, employees, agents, volunteers and representatives are named <br />as an additional insured but only as respects the operations of the named insured except that liability resulting from the additional Insureds <br />sole negligence. <br /> <br />CERnFlCATE HOLDER <br /> <br />CANCELlAnON <br /> <br /> SHOULD ANY OF THE ABCNE DESCRIBED POliCIES BE CANCELLED BEFORE THE <br /> EXPIRATION DATE lllEREOf. THE ISSUING INSURER Wll.LENOEAVORTO MAIL 30 DAYS <br />The City of Santa Ana WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIlE LEFT, BUT FAILURE <br />TO DO so SHALL IUPOSE NO OBLIGATION OR llABlUTY OF ANY KIND UPON TIlE INSURER, <br />20 Civic Center Plaza 1l'S AGENTS OR REPRESENTATIVES. <br />Santa Ana, California 92701 AUTHORIZED REPRESENTATIVE d;~~ <br />Attention: <br /> Jeffrey E. Frick, CEO <br /> <br />ACORD 25 (2001108) <br /> <br />Certificate # 73235 <br /> <br />@ACORD CORPORATION 1988 <br />