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Client#: 661 ,WNINC .6�1C®,! U. CERTIFICATE OF LIABILITY INSURA DATE06120/V CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 09/06120�gCE 11 1 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($), 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: Producer: Mary Wisley LeGrand Willis Insurance Services of PHONE g49 885-1200 A/C No, Ext): Fac Ne�949-8$5-1225 California Inc License#0371719 E-MAIL Servicer: Jan Mentink 18101 Von Karman Ave Suite 600 06105/2012 -- Irvine CA 92612 INSURER(S) AFFORDING COVERAGE MAIC# INSURER A: Philadelphia Indemnity Ins Co 18058 INSURED INSURER 6: Preferred Employers Ins. Co. - --- 10900 Downtown Incorporated - Attn: Vicky Baxter, Executive Director INSURER C-- ------- 305 East 4th Street # 200 INSURER D : : INSURERE-- Santa Ana, CA 92701 GEN'L AGGREGATE LIMIT APPLIES PER: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMRFR- 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. /NSR LTR TYPE OF INSURANCE ADDL I SR SUB _ D __� POLICY NUMBER __u POLICY Epp; _(MM/DDlYYY'l POLICY EXP MMIDDlYYYY LIMITS A GENERAL LIABILITY Y PH PK720402 06105/2011 06105/2012 EACH OCCURRENCE $1 OOD 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR DgMgGETO REPREMISES Ea occurrNTEUence .$100,000 MED EXP (Anyoneperson) s5,000 PERSONAL &ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PES LOC $ A AUTOMOBILE LIABILITY PHPK720402 0610512011 06[051`2012 COMBINED SINGLE LIMIT Eaacclaa" 1,000,000______ BODILY INJURY (Per person) $ ANY AUTO ALL OWNEDX SCHEDULED AUTOS AUTOS BODILY INJURY Pi $ (Per accident) ( ) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident $ A UMBRELLALIA13 I X I OCCUR PHUB345095 6/05/2011 0610512012 EACH OCCURRENCE $1000,000 X EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 DED I X RETENTION $10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY l•f N ANY PROPRIETOR/PARTNER/EXECUTIVE� OFFICEMMEMBER EXCLUDED? L__J (Mandatary in NH) /(yyes, describe under DESCRIPTION OF OPERATIONS below N 1 A WKN1378283 r) ED T] V 1J r _ 0811712011 S TO L 08117/201 �,1r �lt'1 X WC STAT U- OTH- u— _ 1 )LLJ .TS_ E.L. EACH ACCIDENT $1 OOO OOO E.L. DISEASE • EA EMPLOYEE $1,000,000 — E.L. DISEASE •POLICY LIMIT $1 ,000,000 LISA E. STORCK orn y DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional (A:Wedule, !" more space Is requlred) Reference: Fund Raising Events CITY OF SANTA ANA ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS ARE PER FORM CG2026 (07/04) WITH RESPECTS TO GENERAL LIABILITY AND PER FUND RAISING EVENTS ENDORSMENT FORM PI -SE -001 1212005. ww.vi CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 CIVIC CENTER PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 Of 1 The ACORD name and logo are registered marks of ACORD #S854333/M854326 2MSUR