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•""'~ <br />CERTIFICATE OF LIABILITY INSURANCE I <br />DATE (M Mf O D1YYYYy <br />06109l011 <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(les) 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 <br />Aon Risk Services Northeast, Inc. <br />Parsippany NJ Office <br />CONTACT <br />NAME-. <br />PHONE (866] 283-7122 FAX (847) 953-5390 <br />(AIC. No. Ext); AIc. No. <br />E-MAIL <br />ADDRESS: <br />10 Lanidex Center west <br />P.O. Box 608 <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />Parsippany NJ 07054-4608 USA <br />INSURED <br />INSURER A: Zurich American Ins Co <br />16535 <br />AMSC Geomatri x, Inc. <br />2101 Webster St., 12th Floor <br />INSURER B: American Zurich Ins Co <br />40142 <br />------- <br />Oakland CA 94612 USA <br />INSURER C: <br />INSURER D: <br />INSURER E: <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: 570042782707 REVISION NUMBER: <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. Limits shown are as requested <br />LTRICY EFF POLICY EXIP <br />TYPE OF INSURANCE INSR WVD POLICY NUMBER MMjDD MM100"YY LIMITS <br />A <br />GENERAL LIABILITY <br />Santa Ana CA 92702 USA <br />G'LD <br />2 0 12 <br />$1, DOD ,DOD <br />EACH OCCURRENCEDAMAGE <br />X COMMERCIAL GENERAL LIABILITY <br />f�5 <br />PREMISES Ea occurrence)$100 ,DDD <br />CLAIMS -MADE F�] OCCUR <br />MED Exp (Any one person) $5 , 000 <br />PERSONAL & ADV INJURY $1,000,000 <br />GENERAL AGGREGATE $290001000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $2,000,000 <br />POLICY X PRO JECT F_X LOC <br />'°' <br />AUTOMOBILE LIABILITY <br />BAP 4 314 $- 00 <br />_05/01/2011 0$ 01 2UlZ <br />COMBINED SiNGLE LIMIT $1,000,000 <br />E CCident <br />BODILY INJURY ( Per person) <br />X ANY AUTO <br />BODILY INJURY (Per accident) <br />X ALL OWNED SCHEDULED <br />AUTOS iAUTOS <br />X HIRED AUTOS X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE <br />Per accident <br />X Com p/Gol I Ded $1, 0q <br />UMBRELLA LIAB <br />OCCUR <br />WEPONIMEMMU --- <br />EACH OCCURRENCE <br />AGGREGATE <br />EXCESS LIAS <br />CLAIMS -MADE <br />DED RETENTION <br />B <br />WORKERS COMPENSATION AND <br />EMPLOYERS'LIABILITY Y 1 N <br />ANY PROPRIETOR 1 PARTNER 1 EXCUTIVE <br />E <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatary In NH) <br />N I A <br />WC350486610 <br />05/01/2011 <br />05/01/2012 <br />x [WC STATU- ]OTH- <br />TORY LIMITS ER <br />E.L. EACH ACCIDENT $110009000 <br />E.L. DISEASE -EA EMPLOYEE S1,000,000 <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE -POLICY LIMIT S1,000,000 <br />A <br />Archit&Eng Prof <br />EOC938357803 <br />05/01/2011 <br />05/01/20121 <br />Any One Claim $1,000,000 <br />Professional/PollutionAggregate <br />$1,000,000 <br />SIR applies per policy terins <br />& conditions <br />DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) <br />Re: #8586. where required by written contract, The City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives are included as Additional Insureds to General Liability policy and this insurance is Primary and <br />Mon -Contributory with any other -insurance maintained by the Additional Insureds. <br />APPROVED AS TO FORM <br />CERTIFICATE HOLDER _,l //, CANCELLATION <br />. , <br />OV Laura St tt Sheedy <br />` ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE <br />Assistant City Attor <br />POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />City of Santa Ana, M-93 <br />20 Civic Center Plaza <br />Santa Ana CA 92702 USA <br />ACORD 25 (2010105) <br />@1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />d <br />ti <br />0 <br />ti <br />Cv <br />co <br />I- <br />04 <br />v <br />ti <br />0 <br />z <br />v <br />C3 <br />