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.06 '5:� - 36 CERTIFICATE OF LIABILITY INSURANCE i5i2o��' 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 CONTACT NAME. Triad K-3. C. M. Maiara Company, Snc_PNONE (816)224-6100 FAX (610)224-6099 A/C No -M RLs _TGr@@t1@Ctamaiare. com 21045 CaliPa St. 5100 PRODUCERCUSTONEgInO()0027646 INSURER(S) AFFORDING COVERAGE NAIC0 Woodland Hilla CA 91367 INSURED INSURERA. Hartford CaSUSa J- Sna uranca CO PR EMI E Ee ocuartence S 300,000 INSURER B Hartford Sire ZnsurancaCo . LaBal la Ma rV1n, Znc. - INSt/RER—U.6. SQelClalty Zn9 CO 2700 So. Grand AVa INSURER D: INSURER E; /16/2012 Santa Ana CA 92705 INSURER F: COVERAGES CERTIFICATE NUMBERCL116621047 REVISION NUMBER: 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. ILTR TYPE OF INSURANCE UB POLICY NUMBER MMID Y EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE PR EMI E Ee ocuartence S 300,000 A X COMMERCIAL GENERAL LIABILITY CLAIMSIMADE OOCCUR X 23BAN06283 6/16/2011 /16/2012 MED EXP (An one rson) S 10,000 ONAL B ADV INJURY E 1,000,000I ENE�A-RMETE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: [PERS RODOP AGG S 2,000,000 X POLICY PRO- LOC S 8 AUTOMOBILE UASILITY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS - 72TJZCA60364 APPROVED A 6/16/2011 TO FORM /16/2012 COMBINED SINGLE LIMIT (Ea ecr_) S 1,000,000 BODILY INJURY (Per Person) S BODILY INJURY (Per cudenl) $ PROPERTY DAMAGE (Per aCGdsnt) S Drive car S X NON -OWNED AUTOSother Uninsured motorist co lined S 1,000,000 X UMBRELLA LIAB X OCCUR aUla CC y EACH OCCURRENCE S 5,000,000 EXCESS LIAB CLAIMS -MADE .4'sista ri Attorney AGGREGATE S 5,000,000 DEDUCTIBLE S A X RETENTION S 10 000 72SHANU6283 6/16/2011 6/16/2012 S 8 WORKERS CONPENSATON AND EMPLOYERS' UABK_I Y Y I N ANY PROPRIETORIPARTNER/EXECUTIVE OMF^Cd.tR/MEntNXR EXCLUDED? ( ry ) NIA 72WZCRQ5643 6/16/2011 6/16/2012 X WC STATU- MTj 0TH - E.L_ EACHACCIDENT S 1 DOD DOD E.L. DISEASE - EA EMPLOYE S 1,000,000 I1 yea deacrihe under DE SCS IPTION OF OPERATIONS I—— E.L. DISEASE - POLICY LIMIT $ X. 000 000 C Pro££@a L.T B3_ Liability 331020500 6/16/2011 6/16/2012 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AIt h ACORD 101, Addltlonal Remerlla Schedule, K mora epe Ie required) City of Santa Ana is included as Additional 2naured per tsae Businaass Liability Coverage form SSOOOB and a General Liability Waiver or Subrogation applies to the carti Picata holder par form SSOOOB. mbootha@aanta-mna. org City of Santa Ana Attn: Marilyn Boothe 20 Civic Cantor Plaza (M-36) Santa Ana, CA 92702 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 INS025 (200600) The ACORD name and logo are registered