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-2O /C) - O /<::�) CERTIFICATE OF LIABILITY INSURANCE DATE (O 3/220111 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such end—ment(s)- PRODUCER AOn Risk insurance Services West, Inc. LOs Angeles CA Offi Ce 707 Wi l shi re Boulevard Sui Le 2600 CONTACT NAME: (NCNNo. Ezg: C866> 283-7122 aC No : (8473 953-5390 E-MAIL ADDRESS: INSURER(3) AFFORDING COVERAGE NAIL # Los Angeles CA 90017-0460 USA INSURED INSURER A: National Union Fire Ins Co Of Pittsburgh 19445 Tetra Te Ch. InC. 3475 E. Foothill Boulevard Pasadena CA 91107-6024 USA INSURER B: insurance Company of the State Of PA 19429 INSURER C, Chariis Specialty Insurance Company 26883 INSURER D: Lexington insurance Company 19437 INSURER E: INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED A NMED 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. Limits shown are as requested LTR TYPE OF INSURANCE INSR W VD POLICY NuMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY GL EACH OCCURRENCE S1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occu-- S1,000,000 CLAIMS -MADE %] OCCUR MED EXP (Any ona parson) $10 , 000 % X,C,U Coverage PERSONAL S ADV INJURY S1,000.000 1,000,000 GENERAL AGGREGATE S2,000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2 . 000 , 000 POLICY X PRO- J,E X LOC A AUTOMOBILE LIABILTY CA 17 7 7 1010112011 10/01/2012 COMBINED SINGLE LIMIT S2,000,000 BODILY INJURY (Per Parson) ANY AUTO BODILY INJURY (Per accl —) ALL OWNED SCHEDULED AUTOS JX NON -OWNED PROPERTY DAMAGE HIRED AUTOS HAUCS AUTOS Par acckfan[ D X UMBRELLAUAB X OGGUR TH1100027 101011201T IOIOX12012 EACH OCCURRENCE $5.000,000 EXCESS LIAR CLAIMS -MADE AGGREGATE $ 5 , 000 , 000 DEO I RETENTION B WORKERS COMPENSATION AND WC20635697 10 O1 201110 Ol 2012 WC STATU- OTH- X TORY LIMITS B EMPLOYERS' LIABILITY YIN WC20635698 10/Ol/ 201110/Ol/ 2012 E.L. EACH ACCIDENT $1,000,000 B ANY PH R/EXECUTIVE N N/A WC20635699 10101120111010112012 OFFIOERIMIE ER/PARTN (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE S1, 000, 000 11 y tla.-ba untlar DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000.000 C Contractor Prof COP51952583 10/Ol/2011 10/O1/2012 Each Clain 5, 000, 000 Prof/Poll Liab Agggregate $5, 000, 000 DESCRIPTION OF OPERATIONS / LOCATK)NS / VEHICLES (Attach ACORD 101,—111onal Remarks Schedule, It more apace Is re imd) Stop Gap Coverage for the following states: OH, WA, wY. .A1'PR.QA/1A AS .TO FORM aura Stitt S edy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRAT10. DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ci ty Of Santa Ana AUTHORIZED REPRESENTATIVE Public works Sieve wProject Manager Daisy 220 S. Daisy Ave✓/�[J�%i/'/ Santa Ana CA 92703 USA 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD