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DATE(MMIDD/YYYY) ACORD,m CERTIFICATE OF LIABILITY INSURANCE 1 01/21/2010 PRODUCER CERTIFICATE LIABILITY(SIMPLIFIED) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh Affinity Group Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR a service of Seabury 8r Smith I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 14575 Des Moines, IA 50306 800-503-9227 INSURED Spencer Grant c/o Spencer Grant 31512 Flying Cloud Drive Laguna Niguel, CA 92677-2711 INSURERS AFFORDING COVERAGE NAIC # INSURER A: New Hampshire Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN8R ADD'L POLI Y —EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MM/DDlYY A GENERAL LIABILITY RGL-7242632-03 09/01/2009 09/01/2010 EACH OCCURRENCE $1,000,000 DAMAGE TRENTED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 1 00,000 CLAIMS MADE F OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS — COMP/OP AGG $ 1 000 000 LOC ` A Santa Ana, CA 92701 AUTOMOBILE LIABILITY RGL-7242632-03 09/01/2009 09/01/2010 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) !1A!`nOn !`noonoATlnN 10RR ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per person) SCHEDULED AUTOS BODILY INJURY X HIRED AUTOS (Per accident) X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) AUTO ONLY — EA ACCIDENT $ GARAGE LIABILITY OTHER THAN EA ACC $ AGG $ AUTO ONLY. EACH OCCURRENCE $ EXCESS/UMBRELLA LIABILITY OCCUR � CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ ATUACCT OTH- WORKERS COMPENSATION AND TWO TORY LIMITS ER E.L EACH ACCIDENT $ H EMPLOYERS' LIABILITY E.L DISEASE — EA $ EMPLOYEE ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/ MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L DISEASE — POLICY LIMIT $ OTHER A ADDITIONAL INSURED -STATE OR RGL-7242632-03 09/01/2009 09/01/2010 FORM CG20120798 POLITICAL SUBDIVISION - PERMITS DESCRIPTION OF OPERATIONS/LOCATIONSNECHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Effective 01/21/2010 include as additional insured: Certificate Holder (CG2012) but only with respects to the named insured's actions and / or negligence with regards to the stock photo shoot event to be held at various police facilities and city locations on 01/21/2010 through term of policy. GtK I III 1 t nVLUr_M- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION �P OVED DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN The City of Santa Ana A$ TO R� !/ FORM NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 Civic Center Plaza ` IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Santa Ana, CA 92701 / % Teres REPRESENTATIVES. udd AUTHORIZED REPRESENTATIVE Deputy City Attorney !1A!`nOn !`noonoATlnN 10RR ACORD 25 (2001/0$)