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C1916% ACORD,a CERTIFICATE OF LIABILITY INSURANCE DATE02708YYYY) 09 /EIN DD PRODUCER LIC #OD10299 1- 949 -297 -4900 venture Pacific Insurance Services, Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INSR R HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26487 Rancho Parkway South ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# Lake Forest, CA 92630 29424 INSURED Culbertson Adams & Associates, Inc. INSURERA. HARTFORD CAS INS CO INSURERS: OAR RIVER INS CO 34630 85 Argonaut, Suite 220 INSURERC HOUSTON CAB CO 42374 INSURER D. Aliso Viejo, CA 92656 _ -- INSURER E: $300,000 MEDEXP(AnyonePerson) COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR R DD'L - Y NUMBER POLIC POLICYEFFECTIVE DATE MMIDDI POUCYEXPIRATION DATE MMIDDrYY) LIMOS A GENERALLIABILITY 72SBAN11293 08/01/08 08/01/09 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY )M=ETO] RENTED —_ PREMISES(Eacccurence ) $300,000 MEDEXP(AnyonePerson) CLAIMSMADE X7 OCCUR __$10,000 PERSONAL& ADV INJURY 52,000,000 ' GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS COMPIOPAGG $4,000,000 X POLICY F 'ERCT LOC A AUTOMOBILE LIABILITY 72SHANI1293 08/01/08 08/01/09 COMBINED SINGLE LIMIT $2,000,000 ANY AUTO (Eaacndent) BODILY INJURY ALL OWNED AUTOS $ SCHEDULED AUTOS (Per Person) X HIRED AUTOS BODILY INJURY I $ X NON -OWNED AUTOS — I Per..,Jert) PROPE RTY DAMAGE 5 (PerawidI GARAGE LIABILITY', _ , AUTO ONLY - EA ACCIDENT $ ANY AUTO I ..: EA ACS $ OUTOONLYN AGG EXCESSIUMBRELLA LIABILITY / ✓ EACHOCCURRENCE $ OCCUR CLAIMS MADE' - AGGREGATE S DEDUCTIBLE S RETENTION S $ e WORKERS COMPENSATION AND 2210013354 -081 08/31/08 08/31/09 X WCSTATU- OTH _._.TORY LIMITS __. ER- EMPLOYERS'LIABILITV ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT C$1,000,000 'OFFICER /MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE $1,000,000 If yes, tlesonee under As PROVISIONS below E. L. DISEASE - POLICY LIMIT $1,000,000 OTHER C Professional Liability H70616295 10/08/07 10/08/08 Claims Made Form 3,000,000 Aggregate 3,000,000 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Except 10 days for non payment of premium. CITY OF SANTA ANA, ITS OFFICERS, AGENTS, VOLUNTEERS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED PER HARTFORD FORM ATTACHED. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001108) eokuda 9681887 Certificate Delivery by CerlificatesNow - www.ConfinTNelcom - 877.669.8600 ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL AIII MAIL 30 DAYS WRITTEN PLANNING AND BUILDING AGENCY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, %xaci{re wSx>nu�I�oarAr�clox tmuaw wwi{x o7Nlxix�iut9wrtiKilxi{I{X 20 CIVIC CENTER PLACE X EIfpNO( CyXXXX% XX XXXX%%X% XX %XXXXX % %XX%XXXXXX%XX%XXXXXXXX AUTHORIZED REPRESENTATIVE SAMTA ANA, CA 92702 USA ACORD 25 (2001108) eokuda 9681887 Certificate Delivery by CerlificatesNow - www.ConfinTNelcom - 877.669.8600 ACORD CORPORATION 1988