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11
<br />
<br />
<br />IYYYY)
<br />DATE MMID
<br />4L-vKU_ CERTIFICATE OF LIABILITY INSURANCE
<br />1
<br />
<br />PRODUCER (818) 598-8900 FAX: (818) 598-8910 6
<br />/1
<br />009
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
<br />Venbrook Insurance Services, CA Lic OD80832 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
<br />
<br />6320 Canoga Avenue HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
<br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
<br />12th Floor
<br />Woodland Hills CA 91367 INSURERS AFFORDING COVERAGE NAIC #
<br />INSURED INSURER A: Hartford Fire Insurance 19682
<br />Overland Pacific & Cutler Inc. INSURER B: The Hartford
<br />100 West Broadway Suite 500 INSURER c: Westchester Fire
<br />
<br />Long Beach CA 90802 INSURER D:
<br />
<br />O INSURER E:
<br />C
<br />VERAGES
<br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED
<br />NOTWITHSTAND
<br />REQUIRE
<br />.
<br />ING ANY
<br />MENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
<br />THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T
<br />
<br />AG RE ATE LIMITS SHOWN MAY HAVE BEEN REDU ED BY PAID CLAIMS HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
<br />INSR ADD'L
<br />TYPE OF INSURANCE .
<br />POLICY NUMBER POLICY EFFECTIVE
<br />DATE MMIDD/YY POLICY EXPIRATION
<br />DATE MM/DDIYY
<br />LIMITS
<br /> GENERAL LIABILITY
<br />
<br />X EACH OCCURRENCE $ 1,000,000
<br />
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />IT
<br />DAMAGE
<br />PREM SESOEa occurrence) $ 300,000
<br />
<br />X CLAIMS MADE
<br />OCCUR 72LTUNTR7859 6/1/2009 6/1/2010 MEDEXP An one person) $ 10,000
<br /> $10,000 BI&PD Ded.
<br /> PERSONAL& ADV INJURY $ 1,000,000
<br /> Per Claim
<br />
<br />' GENERAL AGGREGATE $ 2,000,000
<br /> GEN
<br />L AGGREGATE LIMIT APPLIES PER:
<br />
<br />E
<br />O PRODUCTS - COMP/OP A G $ 2,000,000
<br /> POLICY X J
<br />C
<br />T LOC
<br /> AU TOMOBILE LIABILITY
<br /> X ANY AUTO COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />A
<br /> ALL OWNED AUTOS 72UUNTR7859 6/1/2009 6/1/2010
<br />
<br />X
<br />SCHEDULED AUTOS BODILY INJURY
<br />(Per person)
<br />$
<br /> t ?,
<br />? U ??1Vl
<br /> X HIREDAUTOS ^^ YO
<br />a 1 v BODILY I
<br />
<br />X
<br />NON-OWNED AUTOS
<br />P1D C' NJURY
<br />(Per accident)
<br />$
<br /> X P „
<br /> Comp Ded. $1,000
<br />
<br />X
<br />Coll Ded
<br />$1 000 PROPERTY DAMAGE $
<br /> . (Per accident)
<br /> GARAGE LIABILITY . SLltt '
<br /> a Ia
<br />i ('(irr} AUTO ONLY - EA ACCIDENT $
<br /> ANY AUTO t City A
<br /> ?S$1S an OTHER THAN EA ACC $
<br /> AUTO ONLY:
<br />
<br />EXC
<br />ESS/UMBRELLA LIA AGG $
<br /> BILITY
<br />
<br />X
<br />EACH OCCURRENCE
<br />$ 2,000,000
<br /> OCCUR CLAIMS MADE $ 2,000,000
<br />B $
<br /> DEDUCTIBLE 72RHUTR7849 6/1/2009 6/1/2010
<br />
<br /> RETENTION $
<br />$ WORKERS COMPENSATION AND EMPLOYERS' LIABILI
<br />TY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? E.L. EACH ACCIDENT $ 1,000,000
<br />72WETQ9133
<br />If yes, describe under 6/1/2009 6/1/2010
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />SPECIAL PROVISIONS below
<br />
<br />C OTHER Professional Liab. 624412763002 E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />6/1/2009 6/1/2010
<br />
<br />Claims Made Ea. Claim $ 2,000,000
<br /> Aggregate $ 2,000,000
<br />Deductible $ 50,000
<br />DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
<br />The City of Santa Ana, its officers, agents, employees, con
<br />additional insured per attached endorsement #CG20260704
<br />h sultants, special counsel & representatives included as
<br />w
<br />e
<br />conditions, and exclusions. re required by contract. Subject to policy terms,
<br />*10 DAY NOTICE OF CANCELLATION FOR NON-PAYMENT OF PREMIUM
<br />City of Santa Ana
<br />Public Works Agency,
<br />Attn: Sheri Barkley
<br />P.O. Box 1988
<br />Santa Ana, CA 92702
<br />ACORD 25 (2001108)
<br />INS025 (0108).08a
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
<br />EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
<br />M-36 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
<br />FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
<br />INSURER, ITS AGENTS OR REPRESENTATIVES.
<br />AUTHORIZED REPRESENTATIVE
<br />Chastity Harry/CH A"VA"v-
<br />ACORD CORPORATION 1988
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