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CERTIFICATE OF LIABILITY INSURANCE
<br />(MM/DD/YYYY)
<br />P�l
<br />2/30/2010
<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 endorsed. If SUBROGATION 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 />PRODUCER Spectrum Risk Management
<br />CONTACT NAME
<br />74 Discovery
<br />Irvine, CA 92618
<br />PHONE-(A/G.._dQ.Exsl 949 75.6 5730__ FAX {ac Ho);_. 949-756 5740 ...__
<br />E-MAIL ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE ! NAIC #
<br />INSURER A: Mt. Hawley Insurance Co.
<br />www.spectrumrisk.com OC77485
<br />INSURED TSCM Corp
<br />Jamestown Lane
<br />INSURER B : American Economy Ins CO
<br />Huntington
<br />Huntington Beach CA 92647
<br />INSURERC: St. Paul Fife & Marine Ins Co
<br />/
<br />I INSURERD: Everest National Insurance Co.
<br />INSURER E
<br />/
<br />INSURER F :
<br />COVERAGES CERTIFICATr *UMRFR- C11Fq'V17 REV! -,Ink] kll USIED•
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICY NUMBER
<br />POLICY EFF POLICY EXP
<br />MM/DDIYYYY ! (MMIDDrryyyl
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />MGLO172984
<br />1/1/2011 '..1/112012
<br />EACH OCCURRENCE '',$ 2,000,000
<br />COMMERCIAL GENERAL LIABILITY''
<br />!PREMISESa occur ante)''. $ 50,000
<br />CLAIMS-MADEOCCUR,
<br />MED EXP (Any one person) $ 5,000
<br />PERSONAL & ADV INJURY "', $ 1,000,000
<br />GENERAL AGGREGATE'', $ 2,000,000
<br />I
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY i PRO- JECT LOC
<br />PRODUCTS - COMP/OP AG $ 1,000,000
<br />',$ ,
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />02CE20555220
<br />1/1/2011 1/1/2012
<br />COMBINED SINGLE LIMIT
<br />�Ea accident) $ 1,000,000
<br />ANY AUTO _
<br />ALL OWNED SCHEDULED
<br />AUTOS AUTOS
<br />�
<br />BODILY INJURY (Per person) $
<br />i BODILY INJURY Per accident
<br />( )$
<br />NON -OWNED
<br />HIRED AUTOS AUTOS
<br />_
<br />PROPERTY DAMAGE
<br />(Per accident)'', $
<br />$
<br />$
<br />C
<br />UMBRELLA LIAB
<br />OCCUR
<br />QK04501017
<br />1/1/2011 i 1/1/2012
<br />EACH OCCURRENCE $ 4,000,000
<br />EXCESS LIAB''.
<br />CLAIMS -MADE
<br />!,
<br />AGGREGATE ! $ 4,000,000
<br />DED r/ RETENTION $10,000
<br />$
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? ❑Y
<br />N / A
<br />CA10000979101
<br />7/1/2010 7/1/2011
<br />WC srnru- O7 H-
<br />TOR, LIMITS ER
<br />E.L. EACH ACCIDENT $ 1,000000
<br />E.L. DISEASE - EA EMPLOYEE; $ 1,000000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT'', $ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />i
<br />I
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) I
<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 DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Community Development Agency
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Carolyn Fullerton
<br />AUTHORIZED REPRESENTATIVE
<br />20 Civic Center Plaza M-25
<br />Santa Ana CA 92701
<br />/L/j ,'�!1✓'`�—�
<br />J { �I
<br />Jim Waterhouse
<br />01988-2010 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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