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<br />ACORR, CERTIFICATE OF LIABILITY INSURANCE A14n I!is 444DATE
<br />05/29/2009)
<br />PRODUCER (619) 574-6220 FAX (619) 574-6288
<br />Insurance Office of America, Inc.
<br />DBA IOA Insurance Services
<br />1775 Hancock Street, Ste. 180
<br />San Diego, CA 92110
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURED Scott Fazekas & Associates, Inc.
<br />9 Corporate Park Drive
<br />Irvine, CA 92606
<br />INSURERA: Travelers P&C Co. of America
<br />25674
<br />INSURERB: One Beacon America Ins. Co.
<br />INSURERc: Beazley Ins Co
<br />37540
<br />INSURER D:
<br />INSURER E:
<br />COVERAGES
<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 />NSR
<br />LMINSR
<br />DD'
<br />TYPE OF INSURANCE
<br />POLICY NUMBER
<br />POLICY EFFECTIVE
<br />POLICY EXPIRATION
<br />LIMITS
<br />GENERAL LIABILITY
<br />68022521_18A
<br />06/05/2009
<br />06/05/2010
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS MADE [ X] OCCUR
<br />DAMAGE TO RENTED
<br />PR PnrA)
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />A
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY X PRO LOC
<br />JECT El
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />68022521_18A
<br />06/05/2009
<br />06/05/2010
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$
<br />Included
<br />BODILY INJURY
<br />(Per person)
<br />$
<br />A
<br />ALL OWNED AUTOS
<br />SCHEDULED AUTOS
<br />HIRED AUTOS
<br />NON -OWNED AUTOS
<br />X
<br />BODILY INJURY
<br />(Per accident)
<br />$
<br />X
<br />No Co. Owned Autos
<br />X
<br />PROPERTY DAMAGE
<br />(Per accident)
<br />$
<br />GARAGE LIABILITY
<br />AUTO ONLY - EA ACCIDENT
<br />$
<br />ANY AUTO
<br />OTHER THAN EA ACC
<br />AUTO ONLY: AGG
<br />$
<br />$
<br />EXCESS/UMBRELLA LIABILITY
<br />X OCCUR CLAIMS MADE
<br />CUP6527Y301
<br />06/05/2009
<br />06/05/2010
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />AGGREGATE
<br />$ 1,000,000
<br />A
<br />$
<br />RDEDUCTIBLE
<br />$
<br />X RETENTION $ 0
<br />$
<br />WORKERS COMPENSATION AND
<br />406017268
<br />06/05/2009
<br />06/05/2010
<br />X WC STATU- OTH-
<br />B
<br />EMPLOYERS' LIABILITY
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED?
<br />If yes, describe under
<br />SPECIAL PROVISIONS be!ov.,
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />E.L. DICEASE -POLICY LIMIT
<br />$ 1,000,000
<br />C
<br />P
<br />rofessional Liability
<br />laims Made
<br />V15THZ09PNPA
<br />06/05/2009
<br />06/05/2010
<br />$1,000,000 each claim
<br />$1,000,000 aggregate
<br />$20,000 deductible
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
<br />te: All Operations of the Named Insured
<br />A ty of Santa Ana, its officers, employees, volunteers, representatives and agents are
<br />:ertificate holders and additional insured per the attached endorsment.
<br />10 day notice of cancellation applies for non payment of premium.
<br />City of Santa Ana
<br />Tonia Zerba
<br />20 Civic Center Plaza (M202WVED AS
<br />P.O. Box 1988 /
<br />Santa Ana, CA 92702
<br />ACORD 25 (2001/08)
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />YQ30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
<br />n
<br />S QAALURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
<br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />K1Tiv Frowell/HOWELK
<br />Assistant Ci`y ...tiurney
<br />©ACORD CORPORATION 1988
<br />
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