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r ACORD- v5V CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) PRODUCER 12/12/08 HRH Professional Practice THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Brokers, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2030 Main Street, Suite 350 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Irvine, CA 92614 -7248 INSURERS AFFORDING COVERAGE INSURED NAIC # BUCKNAM & ASSOCIATES, INC. INSURERA: Travelers Property Casualty Co of Am 36161 30131 TOWN CENTER DR STE 295 INSURER B: Travelers Indemnity Company of CT 25682 LAGUNA NIGUEL, CA 92677 INSURER C: Continental Casualty Company 20443 INSURER D: INSURER E: 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. _TR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MM /DD/YY DATE MM /DD/YY LIMITS A GENERAL LIABILITY 6804880L652 09/01/08 09/01/09 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY $1 000 000 � DAMAGE TO RENTED $300 000 CLAIMS MADE L^ OCCUR CITY OF SANTA ANA PUBLIC WORKS AGENCY M -36 ATTN: JASON GABRIEL, PROJECT MGR. PO BOX 1988 Santa Ana, CA 92702 ACORD 25 (2001/08) 1 of 2 #M448619 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL Rb08MRXR MAIL _.A 0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ")tR91 REPRESENTATIVE CCL © ACORD CORPORATION 1988 MED EXP (Any one person) $5000 PERSONAL & ADV INJURY $1 0000 0 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2 000 000 POLICY JET LOC A AUTOMOBILE LIABILITY 680488OL652 09/01/08 ANY AUTO ALL OWNED AUTOS 09/01/09 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY ( Per person) $ SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG $ A EXCESS /UMBRELLA LIABILITY CUP7637Y444 09/01/08 X OCCUR � CLAIMS MADE $ 09/01/09 EACH OCCURRENCE $40000 0 AGGREGATE $4,000 0(0 $ DEDUCTIBLE $ X RETENTION $ 0 $ B WORKERS COMPENSATION AND UB7110Y58A EMPLOYERS' LIABILITY 09/01/0 09/01/09 X WC STATU- OTH- ANYPROPRIETORlPARTNERlEXECUTIVE OFFICER/MEMBER EXCLUDED? S yes, describe under SPECIAL PROVISIONS below E. L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 C OTHER Professional AEA11398868001 01/02/09 Liability 01/02/10 51,000,000 Per Claim DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS GENERAL LIABILITY: CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED ADDITIONAL INSURED PER ENDORSEMENT. 52,000,000 Aggregate ATTACHED / CITY OF SANTA ANA PUBLIC WORKS AGENCY M -36 ATTN: JASON GABRIEL, PROJECT MGR. PO BOX 1988 Santa Ana, CA 92702 ACORD 25 (2001/08) 1 of 2 #M448619 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL Rb08MRXR MAIL _.A 0_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ")tR91 REPRESENTATIVE CCL © ACORD CORPORATION 1988