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CERTIFICATE OF LIABILITY INSURANCE DATE 06/24 /2010 <br />06/24/2010 <br />PRODUCER <br />Aon Risk Insurance Services West, Inc. <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br />D' <br />INSRE <br />Seattle wA office <br />AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />POLICY EFFECTIVE <br />ATE M/DD/YY YY <br />1420 Fifth Avenue <br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />B <br />Suite 1200 <br />Seattle WA 198101 -4030 USA <br />COVERAGE AFFORDED BY THE POLICIES BELOW. <br />ERAL LIABILITY <br />INSURERS AFFORDING COVERAGE <br />NAIC # <br />'HONE- 206 749' 4800 FAx- 206 749 -4860 <br />EACH OCCURRENCE <br />INSURED <br />INSURER A: Fidelity & Guaranty Ins co <br />35386 <br />X <br />T- Mobile USA,, Inc. <br />its Subsidiaries and Affiliates <br />L <br />INSURER B: National union Fire Ins Co of Pittsburgh <br />19445 <br />12920 SE 38th Street <br />Bellevue WAI 98006 USA <br />d <br />INSURER C: Discover Property & Casualty ins Co <br />36463 <br />X <br />o <br />Fidelity & Guaranty Ins U/W <br />25879 <br />0 <br />[INSURERD: <br />INS: united States Fidelity & Guaranty Co. 125887 <br />(Any one person MhV k" <br />COVERAGES SIR annliac nar i-armc and rnnriit4— —F the n^14,. <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY <br />PERTAIN, THE INSORANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. <br />AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED <br />INSR <br />LTR <br />D' <br />INSRE <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />POLICY EFFECTIVE <br />ATE M/DD/YY YY <br />POLICY EXPIRATION <br />DAT MM/DD <br />LIMITS <br />B <br />ERAL LIABILITY <br />GL2264628 <br />05/01/2010 <br />05/01/2011 <br />EACH OCCURRENCE <br />$1,000,000 <br />X <br />COMMERCIAL. GENERAL LIABILITY <br />DAMAGE TO RENTED <br />$1,000,005, <br />1, 000 , 000 <br />X <br />CLAIMS MADE ® OCCUR <br />Contjractual Liability Incl. <br />PREMISES (Ea occurrence) <br />(Any one person MhV k" <br />PERSONAL & ADV INJURY <br />$1,000,000 <br />❑ <br />GENERAL AGGREGATE <br />$2,000,000 <br />GENT, AGGREGATE LIMIT APPLIES PER <br />PRODUCTS - COMP /OP AGG <br />$2,000,000 <br />❑ POLICY E] PRO- LOC <br />JECT <br />B <br />B <br />AUTOMOBILE LIABILITY <br />X ANY AUTO <br />ALL OWNED AUTOS <br />SCHEDULED AUTOS <br />cA9835798 <br />ADS <br />CA 9835799 <br />MA <br />05/01/2010 <br />05/01/2010 <br />05/01/2011 <br />05 /01 /2011 <br />COMBINED SINGLE LIMIT <br />(Ea accident) <br />$2,000,000 <br />BODILY INJURY <br />( Per person) <br />HIRES AUTOS <br />NON OWNED AUTOS <br />A S I y T Y RO 1I <br />' ) �) � <br />G. C <br />FORM <br />. - - - -- <br />BODILY INJURY <br />(Per accident) <br />PROPERTY DAMAGE <br />(Per accident) <br />GARAGE LIABILITY <br />As,is <br />.? i. i_ Ii;y /%U( ; U l <br />r T7 <br />AUTO ONLY • EA ACCIDENT <br />ANY AUTO <br />H <br />OTHER THAN EA ACC <br />AUTO ONLY <br />AGG <br />B <br />EXCESS/ BRELLALIABIIITY <br />ElOCCUR ❑ CLAIMS MADE <br />15972273 <br />05/01/2010 <br />0510112011 <br />EACH OCCURRENCE <br />AGGREGATE <br />$5,000,000 <br />HDEDUCTMLE <br />RETENrON <br />A <br />E <br />D <br />WORKERS COMP NSATION AND <br />EMPLOYERS' LIABILITY Y / <br />ANYPROPRTETOR/IPARTNER /EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />D W 4 <br />ADS <br />D003W00409 <br />AZORWI <br />D003W00410 <br />05/01/2010 <br />05/01/2010 <br />05/01/2011 <br />05/01/2011 <br />X <br />C STATU- <br />LIMITS <br />OT - <br />H <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$1,000,000 <br />Ifyes, describe under SPECIAL PROVISIONS below <br />HI <br />OTHER <br />DESCRIPTION OF OPERAT <br />site No.: LA333 <br />Ana is an Addit <br />above location <br />NS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS <br />1B Site Name: ROSita Park site Address: 4600 W. Hazard Ave Santa Ana CA 92703. city of Santa <br />onal insured for General Liability solely as respect to operations of the Named Insured at the <br />f required by contract. The insurance coverage provided shall be primary and any other insurance <br />C'N.UTTFii-ATL' u <br />T rlCD 1 <br />I 1 Vl\ <br />city Of Sant td Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />Attn: Laura Sheedy DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <br />20 Civic Cente r Plaza 8th floor 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, <br />Santa Ana CA 92 707 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY <br />OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE�a & - �� �. <br />D 25 (2009/01)] ©1988 -2009 ACORD CORPORATION. All rights reserve <br />The ACORD name and logo are registered marks of ACORD <br />-� �1 -11--) <br />00 <br />eo <br />rn <br />N <br />Cn <br />M <br />O <br />O <br />n <br />O <br />z <br />L <br />U <br />J <br />