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ACORN CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYYY) TM. TR NSRL 12/14/2010 PRODUCER Pbone: (800) 3a 075 Few (555) 42241519 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FITNESS AND WELLNESS LIMITS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 80 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR OLANA BEACH CA 92075 }� 201! APR 19( p M 3' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, X COMMERCIAL GENERAL LIABILITY NSURERS AFFORDING COVERAGE NAIC N A my Lid{: 031154 c.0 TOB ENTED PREMISES §100,000 Ee occre nc ) INSURED Choc V La c ` - . "/ / �.:�i tpMRER A: Phllatlalphla Intlemnity Insurance Company 18058 SURER B: 4 Fabrlano 'v URER C: Irvine CA 92620INSURER X D: NSURER E: V V V trWL�tJ HE 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. AGRREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR NSRL TYPE OF INSURANCE POLICY NUMBER DATE (MM/OD/YY) DATE (MM/DD/YY) LIMITS AILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON GENERAL LIABILITY PHPK661902 12/17/2010 12/17/2011 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY ttention: c.0 TOB ENTED PREMISES §100,000 Ee occre nc ) LAI MS MADE E OCCUR MED. EXP (Any one person) S §2,500 A X X PROFESSIONAL LIABILITY PERSONAL & ADV INJURY 1.000,000 ENERAL AGGREGATE 3,000,000 EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. 3,000,000 X OLICY ROJ- CTOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT NY AUTO Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS Per person) BODILY INJURY (RED AUTOS ON -OWNED AUTOS Per accident) PROPERTY DAMAGE Par accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 0HERTHAN EA ACC NY AUTO UTO ONLY: AGG —EXCESS / UMBRELLA LIABILITY Appg �) C Y �tL AS 1 EACH OCCURRENCE ::]--CUR CLAIMS MADE - L AGGREGATE EDUCTIBLE 8ll1.'a Stit Sri CL)_Y ETENTION$ Assistant City t"ri1C1' ORKERS COMPENSATION AND EMPLOYERS'TgTU-TORY THER (ABILITY IM ITs NY PROPRIETOR/PARTNER/EXECUTIVE.L. EACH A (DENT FFICER/MEMBER EXCLUDEOi yaa, aawcrlba unaar sPEc1AL PRowsloNs below E.L. DI "A"'EMPL YEE E.L. DI EASE -P LI Y LIMIT THER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It la understood and agm,d that the following entity la added as an addIOonal Insured but only as respect. the oparatlona of the named Insured except that liability resulting from the ddltlonal Inaunada sole negligence. The City of Santa Ana, Its Respective OfOcers, Employees, Agents, Volunteers and Repreee.tativee. CERTIFICATE HOLDER - CANCELLATION City of Santa Ane, HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 0 Civic Cental Plata M-25 XPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 S-1, Ana , CA, 92701 AYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT AILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON HE INSURER, ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE I ( �— ttention: ACORD 25 (2001/2) Certificate # 84562 ACORD CORPORATION 1988