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' 6.? ;^ CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD 0/26/200110 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NACONTACT ME: Joanne Sargeant JOHN SARGEANT INSURANCE AGENCY PHONE 818)547-1975_ IAIC.NoY. ?FA`X (818)242-5288 750 FAIRMONT AVENUE SUITE 100 E-MAIL oanne@ glendaleins.com ADDRESS: P. O. BOX 831 PRODUCER 00000208 CUSTOMERID p:_ GLENDALE CA 91209-0831 INSURER(S) AFFORDING COVERAGE NAIC-# INSURED INSURERA:First National Ins. Co. of 24724 BARTEL-ASSOCIATES, LLC INSURERB:American States - Ins. Co. 19704 INSURER C: Indian -Harbor Insurance Co. 36940 - - - - - 411 BOREL AVE STE 445 INSURER D : INSURER E SAN MATED CA 94402 INSURER F: COVFRAnFS L`CDTICIf`ATC L11 1all0Cn.r•T-1 n1i fl13Crl1 nee ..? ................___ THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - TADDLTgU13R1 POLICY EFF---i POLICY EXP__ -- LTR TYPE OF INSURANCE INSR D' POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1_'000'000 - LIABILITY DAMAGE TO RENTED A COMMERCIAL PREMISES fEa occurrence] $ 1,000,000 OCCUR 5CC12442950 9/1/2010 9/1/2011 MED EXP (Any one person) $ 10,000 I -- - - PERSONAL & ADV INJURY $ 1,060,000 GENERAL AGGREGATE $ 2, 000, 000 --- - - - X N POL CREGATE LIMIT APPLIES PER. PRODUCTS COMP/OP AGG r $ 2,000,000 1PRO- - - $ COMBINED SINGLE LIMIT $ 11000,000 AU7 ANDY AUTOIABILITY (Ea accident) 25CC12442950 9/1/2010 9/1/2011 BODILY INJURY (Per person) $ A ALL OWNED AUTOS - 1 SCHEDULED AUTOS 11 BODILY INJURY (Per accident) j $ PROPERTY DAMAGE X HIRED AUTOS ?n (Per accident) $ X NON-OWNED AUTOS $ UMBRELLA LIAB IOCCUR _ EACH OCCURRENCE $ Y EXCESS LIAB CLAIMS-MADE I ,,`, ;AGGREGATE i $ DEDUCTIBLE $ _ RETENTION $ $ -- B WORKERS COMPENSATION WC STATU 0TH'. ANY PROPRIETOR/PARTNER/EXECUTIVE AND EMPLOYERS' ' FILER/ry in NH) LIABILITY 01WC14518350 11/17/2010 E.L EACH A CI DENT ER $ 11 000, 000_ OF EXCLUDED? N/A`' 11/17/2011 If yes, describe under E L DISEASE - EA EMPLOYEE $ DES 1 , 000 ,000 DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 11000,000 C MPPOO1715206 9/1/2010 9/1/2011 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER IS HEREBY NAMED AS ADDITIONAL INSURED ON POLICY #: 25CC12442950 AS RESPECTS OPERATIONS OF THE NAMED INSURED ONLY. SEE ATTACHED FORM #: CG76350207. COVERAGE UNDER POLICY #: 25CC12442950 IS PRIMARY & NON-CONTRIBUTORY ABOVE ANY OTHER INSURANCE THE CERTIFICATE HOLDER(S) MAY CARRY. .+?r,r.?....-rte .......?.. i wiv City of Santa Ana ATTN: Robert Cez P. O. Box 1988 Santa Ana, CA 92702 Annon nR r?nnn mn? SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Joanne Sargeant/0116 W 1V55-ZUUV AQORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD