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ACORU0 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 14/2,/2010 FPRODUCER (818) 334 -5120 FAX: (888) 827 -1185 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION te Risk Insurance Solutions ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lic# OG40499 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 31st Street Newport Beach CA 92663 __�INSURERS AFFORDING COVERAGE +NAIC # INSURED Simon, Laura 1227 E. 14th Street INSURER k Markel Insurance Company INSURER B: INSURER C: INSURER D: Santa Ara CA 92701 INSURER E: I 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 OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. wwi DD'Lr ... POLICY EFFECTIVE fPOUCY EXPIRATION TYPE INSURANCE POLICY NUMBER LIMITS NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL GENERAL LIABILITY EACH OCCURRENCE 1�000,, 000 X1 GENERAL LIABILITY ' _ _ r DAMAGE TO RENTED - PR_E_MISE-S _a occunencac 1$ _ -- 100,000 A _COMMERCIAL CLAIMS MADE �X I OCCUR 3602Br332910 -0 12/16/2009 12/16/2010 MED EXP (Anyone Person) 5 000 i Professional Liab. !, PERSONAL &ADVINJURY $ 1,000, 000 GENERAL AGGREGATE $ 3,000,000 PE N fall APPLIES PER: PRODUCTS - COMP/OP AGG _ _ _ _ - -- $ 1,000,000 _ ! POLICREGATEP X r 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea aomdent ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS ! (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per acr9dent) _ - DAMAGE (PROPERTY Pao Y GARAGE LIABILITY .._._. AUTO ONLY - EA ACCIDENT $ _ ANY AUTO ! OTHER THAN FA ACC- $ - - - - ' FARM AUTO ONLY: AGG $ EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR CLAIMS MADE j AGGREGATE $ FL _ $ DEDUCTIBLE j ,- . 11- 7 r') r.' $ RETENTION $ !$ WORKERS COMPENSATION OTH- .TQRY IMITS AND EMPLOYERS' LIABILITY Y!N -_ _j._ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ -- - - - — -- -- - OFFICERIMEMBER EXCLUDED? ❑ (Mandatoryin NH) E.L. DISEASE - EA EMPLOYEE -- _ - _ - - _ - -- If es, describe under S PECI AL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ I OTHER'' i DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES/ EXCLUSIONSADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Premium and fees are fully earned at inception. Policy does not provide Premises Liability. Certificate holder is listed as an additional insured. ** *The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and volunteers are named as additional insureds ( "additional insureds ") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. r- CDTICW`ATC unt fICD reurt =t I ATinu ACORD 25 (2009101) ®1988-2009 ACORD CORPORATION. All rights reserved. INS025 (2oowl) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Santa Ana DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 20 Civic Center Plaza NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Santa Ana, CA 92701 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Kleid /NANCY ACORD 25 (2009101) ®1988-2009 ACORD CORPORATION. All rights reserved. INS025 (2oowl) The ACORD name and logo are registered marks of ACORD