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ACORt$' CERTIFICATE OF LIABILITY INSURANCE 44--? DATE(MM/DD/YYYY) 11/27/2012 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 CMITIFICATE HOLLER,,, z-? IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol cy(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 TACT : Michelle Sharp N ME Insurance Solutions P(A/C No HONE (949)348-7400 AIC No: (949)348-2373 License #0746539 E-MAIL michelles@ins-solutions.com ADDRESS: 33302 Valle Rd, Suite 200 INSURERS AFFORDING COVERAGE NAIC # San Juan Capistrano CA 92675 INSURERA:Sentinel Ins Co. LTD 11000 INSURED INSURERB:Certain Underwriters at Lloyds CPC POWERTEC, INC. INSURERC: 31441 SANTA MARGARITA PKWY INSURER D: STE A390 INSURER E : RNCHO STA MARGA CA 92688 INSURER F: COVERAGES CERTIFICATE NUMBER:12/13 REVISION NIIMRFR- 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. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MM/DD/Yl'YY POLICY EXP MIWDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $ 1,000,000 A CLAIMS-MADE Fx] OCCUR 2SBMAK0672 11/18/2012 1/18/2013 MED EXP (Any one person) $ 10 , 000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 4,000,000 X POLICY PRO LOC $ AUT OMOBILE LIABILITY EOa a8cideDISINGLE LIMIT 2 000 000 A ANY AUTO BODILY INJURY (Per person) $ I ALLOWNED AUTOS SCHEDULED AUTOS 72SBMAK0672 11/18/2012 11/18/2013 BODILY INJURY (Per accident) $ x HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB H CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION W C STATU- EMPLOYERS' LIABILITY DER Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E. L. EACH ACCIDENT $ (Mandatory in NH) If es describe und r E.L. DISEASE - EA EMPLOYE $ y , e DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liability 0009 1/18/2012 11/18/2013 Limit: $ 1,000,000 l i tf Aggregate: $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder named as additional insured per attached form SS0008 to the policy. Apt°r ? ii'l r:v A"I TO FORM (714)647-6956 City of Santa Ana Attn: Clerk of the City Council 20 Civic Center Plaza (M-30) Sana Ana, CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Tony Alessandra/WENL .4-, rk%.vr-,U cv tcv I VIVO) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r7mnnr) m Tha Ar-r)Pn nnma and Innn nra ranicfararl marirc of A(`npn