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Client #: 50903
<br />BUCKASO
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />DATE
<br />12 /312010YY)
<br />12/31/2010
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Willis Ins. Srvcs of CA, Inc.
<br />18101 Von Karman Ave
<br />Suite 600
<br />CONTACT Cora Lim
<br />NAME:
<br />_
<br />PHONE 949 885 -1200 FAX 949- 885 -1225
<br />A/C No Ext : (A/C, No):
<br />E -MAIL
<br />ADDRESS:
<br />RODUCER --
<br />Irvine, CA 92612
<br />CUSTOMER ID #:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURED
<br />30131 8r Associates, Inc.
<br />30131 Too wn Center Drive, Suite 268
<br />Laguna Niguel, CA 92677
<br />INSURER A: Travelers Property Casualty Co
<br />25674
<br />INSURER B: Continental Casualty Company
<br />20443
<br />INSURER C :
<br />GENERAL AGGREGATE
<br />INSURER D
<br />PRODUCTS - COMP /OP AGG
<br />INSURER E,
<br />$
<br />INSURER F:
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AU1 0
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
<br />j THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />DDL
<br />NSR
<br />UBR
<br />AfVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM /DD/YYYY
<br />POLICY EXP
<br />MMIDD /YYYY
<br />-
<br />LIMITS
<br />•
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />_ CLAIMS -MADE 41 OCCUR
<br />- --
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY FRO LOC
<br />1
<br />680488OL652
<br />09/01/2010
<br />�
<br />09/01/2011
<br />-
<br />1
<br />EACHOCCURRENCE
<br />$1,000,000
<br />DAMAG TO RENTED
<br />PREMISES Ea occurrence
<br />$1,000,000
<br />MED EXP (Any one person)
<br />$10,000
<br />PERSONAL BADVINJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP /OP AGG
<br />$2,000,000
<br />$
<br />•
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AU1 0
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />6804�8y80�ff;J,; - ' �'
<br />i
<br />- �,
<br />�,
<br />';,,`d td' i
<br />` Jt
<br />9/01/2010
<br />-
<br />09/01/2011
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$INCL IN GL
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />X
<br />X
<br />$
<br />A
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />X
<br />OCCUR
<br />CLAIMS -MADE
<br />CUP7637Y444
<br />9/01/2010
<br />09101/2011
<br />EACH OCCURRENCE
<br />s4,000,000
<br />AGGREGATE
<br />x4,000,000
<br />JvI�
<br />AI
<br />DEDUCTIBLE
<br />RETENTION $ 0
<br />$
<br />A WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUI IVE
<br />OFFICER/MEMBER EXCLUDED? ❑N
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />N/A
<br />UB711OY58A
<br />09/01/2010
<br />09/01/2011
<br />X WCSTATU- OTH-
<br />T.
<br />E.L. EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />B Professional Liab
<br />7jAiEA113988680
<br />Ded: $5,000 1
<br />1/2/2011
<br />1/2/2012
<br />f
<br />$1,000,000 Per Claim
<br />$2,000,000 Aggregate
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />2011 -2012 PROFESSIONAL LIABILITY POLICY RENEWAL CERTIFICATE
<br />PREVIOUSLY ISSUED ENDORSEMENTS FOR GENERAL LIABILITY AND WORKERS COMPENSATION STILL APPLY.
<br />(See Attached Descriptions)
<br />t t
<br />I
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS.
<br />PUBLIC WORKS DESIGN ENG
<br />ATTN: JUDY ALVARADO AUTHORIZED REPRESENTATIVE
<br />PO BOX 1988 _
<br />©1988 -2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
<br />#S474196/M474102 CCL
<br />
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