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CERTIFICATE OF LIABILITY INSURANCEF-6'7 YYI7iS12012 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: H the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 andorsement s . PRODUCER Rosoann Zirnig The Liberty Company Insurance Brokers PHONE (818)224-6100 CA License No. OD79653 . (818)97{-6099 ADDRESS,RZirnigalibsrtycomoysay.com 21045 Califs Street /16/7013 Woodland 'Hills CA 91367 INSURER(a) AFFORDING COVERAGE NAIC e INSURER A:Hartf Ord CASualty Insurance Cc 9424 INSURED LaBelle Marvin, Inc. wsuRena:Hartford Pire Insurance Co. 9682 INSURERC:Admiral insurance Co 4856 2700 So. Grand Ave INSURER D: I E Santa Ana CA 92705 OEN'OGREGATE LIMIT APPLIES PER PO POLICY X PRO• LOC COVERAGES 10071e:InATE an INSURER F• __......_ 14MVISION 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE GENERAL LIABILITY NVOR L NUMBERCY LI Y e F p LICY eXP 0 YM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X X 28SAMU6283 6/16/2012 /16/7013 EACH OCCURRENCE S 1, 000, 000 _ ES (Fn =urrencel S 300,000 MED EXP CAny oneperson) $ 10,000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE S 2,000,000 OEN'OGREGATE LIMIT APPLIES PER PO POLICY X PRO• LOC PRODUCTS - COMP/OP AGG $ 2,000,000 S 8 AUTOMOBILE Ix LIABILITY ANY AUTO ALL OS SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 2UNCAR0364 /16/2012 /16/2013 LI MIT 1. 1 000 00 BODILY INJURY (Per person) $ -BODILY BODILY INJURY (Per acadenl) $ PROPER DAMAGE [Por AMAsMl $ Dr h $ EACH OCCURRENCE $ 51000,000 A B C X UMBRELLA LIAB X OCCUR EXCESS LIAR CLAIMS -MADE N / A 2WZCRO5643 000001984501 /16/2012 6/16/2012 /16/2012 6/16/2013 6/16/2013 /16/2013e AGGREGATE s 3,000,000 DED I X I R TI N 10,000_281BAW6283 WORKERS COMPENSATION AND AND EMPLOYERS' LIABILITY PROPRIETOWPARTNERIEXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Msndsk"InNH) If yyeeaa describe under DESCRIPTION OF PERATIPOLICY Professional Liability Is U- H- E.L.IDENT $ 1100 0 000 EA EMPLOYE S 1 000 000 PDISEASE LIMIT $ 1 0 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attsch ACORD 101, Addltlenal Remarks schedule, It morespace to required) City of Santa Ana is included as Additional Insured as requiredbywritten contract per the susinemas Liability Coverage form 680008 and a general Liability Waiver of Subrogation applies to the certifioata holder per form 880008. *10 Day Notice of Cancellation applies for Non -Payment of Preniultl p1� ,()V,1ZD AS TO FORM 12.01nalk'AIrs: UM Men mbootheftanta-ana.org, City of Santa Ana Atter: Marilyn soothe 20 Civic Center plaza (M-36) Santa Ana, CA 92702 ACORD 25 (2010/05) INS025 r2oinneLnm Jl SHOULD ANY OF THE ABOVE IIIED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Leach/SDi88T ~��jyL �fZ,Fc.•� ®1988-2010 ACORD CORPORATION. All rights reserved. •••� •+....r.v narun arlu lugv are regla[erea marKe at ACORD