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<br />
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYY)
<br />07/08/08
<br />PRODUCER 0529776 1_510_547_3203 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Diversified Risk Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br /> HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />5900 Christie Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />Emeryville. CA 94608 INSURERS AFFORDING COVERAGE
<br />INSURED INSURER A: OneBeacon A1l1erica Insurance Co.
<br />Geo Design. Inc.; INSURER B: RSUI Indemni ty Company
<br />Benthic, LLC
<br />2121 S. Towne Centre Place, Suite 130 INSURERC:Travelers Indemnity Company
<br />Anaheim, CA 92806 INSURER 0:
<br />, INSURER E:
<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 />ll~~!l TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION l..1MlTS
<br />A ~NERAL UABIl..lTY 718009864-0001 02/01/08 02/01/09 EACH OCCURRENCE $1,000,000
<br /> X COMMERCiAl GENERAL lIABILITY FIRE DAMAGE (Anyone flrel $1,000,000
<br /> I CLAIMS MADE 0 OCCUR MED EXP IAnv one person) $ 10,000
<br /> f- PERSONAl & ADV INJURY $1,000,000
<br /> f- GENERAL AGGREGATE S 2,000,000
<br /> n'lAGG:~lIMIT AP~S PER. PRODUCTS. COMP/OP AGG $ 2,000,000
<br /> POLICY X I ~~g. X lOC
<br />A M.TOMOBILE LIABILITY 718009864-0001 02/01/08 02/01/09
<br /> COMBINED SINGLE LIMIT $1,000,000
<br /> ~ ANY AUTO (Eaacddent)
<br /> - All OWNED AUTOS BODilY INJURY
<br /> SCHEDULED AUTOS (Per person) S
<br /> -
<br /> -" HIRED AUTOS BODilY INJURY
<br /> -" NON-OWNED AUTOS (Per accident) $
<br /> - PROPERTY DAMAGE $
<br /> (Per accident)
<br /> ~GE UABIL'TY AUTO ONLY. EA ACCIDENT $
<br /> ANY AUTO EA Ace S
<br /> OTHER THAN
<br /> AUTO ONLY: AGG $
<br />B W~SS LIABILITY NHA220632 02/01/08 02/01/09 EACH OCCURRENCE $ 5,000,000
<br /> X OCCUR D CLAIMS MADE AGGREGATE $ 5,000,000
<br /> $
<br /> R DEDUCTIBLE $
<br /> RETENTION $ S
<br />C WORKERS COMPENSATION AND PKUB2324C73208 02/01/08 02/01/09 X I WC STATU.., I IOJ,ti-
<br /> EMPLOYERS' LIABILITY
<br /> E.l. EACH ACCIDENT $1,000,000
<br /> Oregon, California, Nevada EL. DISEASE - EA EMPLOYEE $1,000,000
<br /> E.l. DISEASE. POLICY LIMIT S 1,000,000
<br /> OTHER
<br /> .
<br /> .
<br />" .
<br />DESCRIPTION OF OPERATIONSJLOCATIONSNEHICLES/EXClUSIONS ADDED BY ENDORSEMENT/SPEClAL PROVISIONS
<br />General & Auto Liability Additional Insured status granted, if required by written contract/agreement, per attached
<br />OneBeacon Additional Insured endorsement & VCA201 0205.
<br />City of Santa Ana, its officers, employees, agents, volunteers and representatives as additional insured
<br />if required by written contract/agreement.
<br />proj ec t: City of Santa Ana Neighborhood coring
<br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Ten Day Notice for Non-Payment of Premium
<br />SantaAna-l-01
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
<br />Ci ty of Santa Ana ,\l"PRU'ii:D ..-'\3 TO FORM DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
<br /> -
<br /> ~~ 0,,"/0 / /~ NOTK:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
<br />H~id Torkamanha
<br />PO Box 1988 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
<br /> REPRESENTATIVES.
<br /> / :g/ :,{
<br />Santa Ana, CA 92702 [~tl;r,. _,. :.:.~,:\J ' AUTHORIZED REPRESENTATIVE
<br /> , AS~lst~...nity AttlJr:1cy ~~Aill-
<br />
<br />ACORD 25-S (7/97) skargsr
<br />9288947
<br />
<br />@ACORDCORPORATlON 1988
<br />
<br />COVERAGES
<br />
<br />Certificate Delivery by CertificatesNow - www.ConfirmNet.com-877.669.8600
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