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.ACORO CERTIFICATE OF LIABILITY INSURANCE �� DATE (MM/DD/1'YYl7 12/16/2010 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: 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 endorse ment(s). PRODUCER CONTACT NAME: Nancy Rami reZ Elite Risk insurance Solutions CA Lio# OG40499 423 3191 Street PHONE (616)334 -5120 FnAic No:(69e)62T -lles -p'glL S:nramiraz @aliterisk. com PRODUCER 00042156 NB ort Beach CA 92663 INSURERS AFFORDING COVERAGE NAIC # INSURED �� —`�� INSURERA Markel insurance: Com an INSURER B $ 1 , 000 , 000 //�� / w^ Simon, Laura 1227 E 14th $tre @t INSURER C INSURERD: 12/16/201012/16 INSURER E PREMISES Ea oaurrance Santa Ana CA 92701 INSURERF: $ 5,000 COVERAGES CERTIFICATE NUMBER:10 -11 Master REVISION 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 BV 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. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MOLDI CDY EFF IPOL /DICDY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 3602HF332910 -1 12/16/201012/16 /2011 PREMISES Ea oaurrance $ 100 , 000 MED EXP An one arson $ 5,000 PERSONALSADV INJURY $ 1,000,000 X Pr0£assional Liab. GENERAL AGGREGATE $ 3 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 1 , 000 , 000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea arcitlent) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Par eccitlent) $ SCHEDULED AUTOS HIRED AUTOS _ PeOr eceitlentDAMAGE $ $ NON -OWNED AUTOS APPROVED AS O FORM UMBRELLA LIAR OCCUR � Z EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE JOSEPH W. FL TCHER AGGREGATE $ DEDUCTIBLE CITY ATTOR EY $ $ RETENTION $ WORKERS COMPENSATION VVO STATU- OTH- AND EMPLOYERS' LIABILITY �, / N ANY PROPRIETOR/PARTN ER/EXECUTIVE OFFIGER/M EMBER EXCLU DEDi � N / A E.L. EACH ACCIDENT $ E.L_ DISEASE - EA EMPLOYE $ (Mantlatory In NH) I( es, tlescribe untler DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD '101, Atltllfional Remarks Schetlule, Ir more apace is requiretl) Premium and fees era fully earned at incap tion. Policy does not provide Premiaaa Liability. Certificate holder is liatad as an additional insured. •••The City o£ Santa Ana, 1825 W. Civic Cantor Drives, Santa Ana, Ca1i£ornia 92703; its oFficera, employees, aganta and volun tears era named as additional insureds (••additional insureds••) with regard to liability and dafenaa o£ suits arising From the operations and uses performed by or on babel£ o£ the named inaurad. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City o£ Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Recreation Supervisor 1(32 rJ W. C.'1v1C Can tar Dr1Ve AUTHORIZED REPRESENTATIVE Santa Ana, CA 92703 r -. Jeff ]rlaid /NANCY "1" s,.. r� "``tom'..... C -: -=' i _. _ � 25 (2009/09) ©'1988 -2009 ACORD CORPORATION. All rights reserved. n�.avcv tauu7us/ r rrc,wvrw rmrrm mw wy., me rcyra wrcaa .nor na yr r,�.vrtv