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CERTIFICATE OF LIABILITY INSURANCE
<br />DATE(MM/DD/YYYY)
<br />12/30/2010
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - - �' -`, '
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be If SUBROGATION
<br />endorsed. IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />p gCDNTACT
<br />PRODUCER Spectrum Risk Management74
<br />NAME -__
<br />ISCOVeI�/
<br />_: -_
<br />Irvine, CA 92618
<br />-HONE_(A(C No..,Ex tj 949-756 5730..._ FAX tA/c, No);- 949 756 5740_....__
<br />.___E-MAIL_ ADDR_ESS;- _ - _ -_..._
<br />www.spectrumrisk.com OC77485
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED TSCM Corp
<br />INSURER A: Mt. Hawle Insurance Co.
<br />17791 Jamestown Lane
<br />INSURER B : American Economy Ins Co
<br />INsuRERc: St. Paul Fire &Marine Ins Co
<br />Huntington Beach CA 92647
<br />INSURER D: Everest National Insurance Co.
<br />I
<br />INSURER E :
<br />INSURER F
<br />_--_--_-
<br />'—"'"—'"�'"'��"' RCVIJIVIY rYVMCSCK:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE
<br />FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE
<br />TO ALL THE TERMS,
<br />BEEN REDUCED BY PAID CLAIMS.
<br />INSR ADDL SUBR
<br />LTR TYPE OF INSURANCE POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MM/DD/YYYY MM/DD/YYYY LIMITS
<br />A
<br />GENERAL
<br />LIABILITY
<br />MGL0172984
<br />1/1/2011 1/1/2012
<br />EACH OCCURRENCE $ 2,000,000
<br />COMMERCIAL GENERAL LIABILITY
<br />'',
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence) $ 50,000
<br />CLAIMS -MADE OCCUR,
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY ''. $ 1,000,000
<br />GENERAL AGGREGATE ',s 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS -COMP/OP AGG 1 $ 1,OOO,O00
<br />POLICY ',.',, PRO- LOC
<br />B
<br />AUTOMOBILE LIABILITY
<br />02CE20555220
<br />1/1/2011 1/1/2012
<br />COMBINED SINGLE LIMIT
<br />ANY AUTO',
<br />Ea accdent - $ 1,000,000
<br />BODILY INJURY (Per person) $
<br />ALL OWNED SCHEDULED
<br />BODILY INJURY (Per accident)'
<br />AUTOS AUTOS
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />:PROPERTY DAMAGE j
<br />(Per accident) : $
<br />$
<br />$
<br />C
<br />UMBRELLA LIAB'', ✓
<br />EXCESS LIAB
<br />OCCUR
<br />CLAIMS -MADE
<br />QK04501017
<br />1/1/2011 1/1/2012
<br />EACH OCCURRENCE s 4,000,00
<br />AGGREGATE
<br />$ 4,000,00
<br />DED V RETENTION $ 10,000
<br />1$
<br />'$
<br />$
<br />WCSTATU- iOTH-!
<br />TORY LIMITS : ER
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y
<br />CA10000979101
<br />7/1/2010 7/1/2011
<br />I N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />OFFICER/MEMBER EXCLUDED? �
<br />N / A
<br />in NH)
<br />atorydescribe
<br />E.L. DISEASE - EA EMPLOYEE'',, $ 1 ,000,000
<br />if y S,
<br />If yas, describe under
<br />I
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE -POLICY LIMIT $ 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) t
<br />Re: Parking lot sweeping services.
<br />The City its officers, agents, employees are named additional insureds with resepect to the general liability and o
<br />liability per the attached blanket carrier forms.
<br />CERTIFICATE HOLDER
<br />CANCELLATION
<br />The City of Santa Ana
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE. EXPIRATION
<br />Community Development Agency
<br />DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Carolyn Fullerton
<br />20 Civic Center Plaza M-25
<br />AUTHORIZED REPRESENTATIVE
<br />Santa Ana CA 92701
<br />4M
<br />� T l
<br />Jim Waterhouse
<br />©1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />CERT NO.: 9159337 CLIENT CODE: Ginnie Ginnie Clarke 12/30/2010 2:41:54 PM Page 1 of 9
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