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Saco �- -�DD �' — �l <br />CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /1'1'YY) <br />04/24/2011 <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 <br />AOn RI Sk insurance SerVl Ces West, Inc. <br />Seattle WA Office <br />CONTACT <br />NAME: <br />(aC Nib. EZt: �866� 283 -7122 aC No <847� 953 -5390 <br />1420 Fifth Avenue <br />SUl to 1200 <br />EJMAIL <br />ADDRESS: <br />Seattle wA 98101 -4030 USA <br />LIMBS <br />GENERAL LIABILRY <br />INSURERS) AFFORDING COVERAGE <br />NAIC # <br />INSURED <br />T- MOblle USA, ZnC. <br />its 5ubsi diari es and Affiliates <br />INSURER A: Natl Onal UniDn Fl re Ins CO Of Pi itsbU rgh <br />1944$ <br />INSURER B: GreenWl Ch insurance Company <br />22322 <br />INSURER C: Travelers Property Cas Co of America <br />25674 <br />12920 5E 38th Street <br />Bellevue WA 98006 u5A <br />INSURER D: <br />INSURER E: <br />$1, 000.000 <br />MED EXP (Any one Derson) <br />INSURER F: <br />X Contractual Liability Incl. <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. Llmlts shown era as requested <br />LTR <br />TYPE OF INSURANCE <br />IN R <br />WVD <br />POLICY NUMBER <br />MM/DD <br />MM/DD <br />LIMBS <br />GENERAL LIABILRY <br />RGD <br />EACH OCCURRENCE <br />$1, 000 , 000 <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE X� OCCUR <br />PREMISES Ea occurrence <br />$1, 000.000 <br />MED EXP (Any one Derson) <br />$ $ , 000 <br />X Contractual Liability Incl. <br />PERSONAL 8 ADV INJURY <br />$1, 000, 000 <br />GENERAL AGGREGATE <br />$2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />S2 , 000 , 000 <br />POLICY PRO- X LOG <br />B <br />AUTOMOBILE LIABILrrY <br />RAD $ 00257 <br />AOS <br />5 1 2011 <br />OS Ol Ol <br />COMBINED SINGLE LIMIT <br />$2,000,000 <br />BODILY INJURY (Per peson) <br />B <br />X ANV AUTO <br />RAD $0002$8 <br />05/01/2011 <br />05/01/2012 <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS NON -OWNED <br />AUTOS <br />MA <br />BODILY INJURY (Par accitlan[) <br />PROPERTY DAMAGE <br />Par accitlanl <br />'s <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />25030274 <br />05/01/201105/01 <br />/2012 <br />EACH OCCURRENCE <br />$$,000,000 <br />EXCESS LIAR <br />CLAIMS -MADE <br />SIR applies per policy ter <br />5 $ COndl <br />lOnS <br />gGGREGATE <br />$$,000,000 <br />DED X RETENTION <br />C <br />C <br />WORKERS COMPENSATION AND <br />EMPLOYERS' LIABILITY y / N <br />ANY PROPRIETOR /PARTNER /EXECUTIVE <br />oFFlcewMEMBER ExcLUOeo> � <br />N/A <br />HC2J UB474M4$71 <br />AOS <br />HR]uB474M4883 <br />O$ Ol 2011 <br />0$/01/2011 <br />O$ Ol 2012 <br />05/01/2012 <br />WC STATU- OTH- <br />X TORY LIMITS <br />E.L. EACH ACCIDENT <br />$1,000,000 <br />E.L. DISEASE -EA EMPLOYEE <br />$1, 000, 000 <br />(Mantlelory In NN) <br />yil <br />'T s, tlescnba untlar <br />DESCRIPTION OF OPERATIONS below <br />� <br />g1 )�( �, !� (J 1� � � i ( �' I <br />ii <br />r ,/ 91'. jV1 <br />E.L. DISEASE - POLICY LIMIT <br />$1, 000, 000 <br />may. /\ <br />DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 1b�iA�'H8""'i)eiTPr'°'. �chaduN, tl more space Is requlretl) <br />Site NO.: LA33321B Site Name: ROSi to Park Si.ie Ac�dres �460Q W. Ha2ard Ave Santa Ana CA 92703. Cl ty Of Santa Ana is an <br />Additional xnsu red for General Liability sot el by "a31 �el��e� °EiS bpeh'd-t i'o31s of the Named insured at the above location if reraui red <br />by contract. The insurance coverage provided s all be primary and any other insurance maintained by the Additional xnsu re is <br />excess and non- contributory. <br />CERTIFICATE HOLDER CANCELLATION <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE <br />EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE <br />POLICY PROVISION$. <br />Cl ty Of Santa And AUTHORIZED REPRESENTATNE <br />Attn: Laura Sheedy q%� �i <br />20 Civic Center Plaza 8th floor (�� ��r ��ta� �F�r+�s*J 1/' ✓� <br />Santa Ana CA 92707 USA c>K�o <br />©'1988 -20'10 ACORD CORPORATION_ All rights reserved_ <br />ACORD 25 (20'1 O /OS) The ACORD name and logo are registered marks of ACORD <br />m <br />m <br />c <br />m <br />'� <br />V <br />O <br />x <br />N <br />r <br />m <br />N <br />r <br />Z <br />qm <br />fi <br />�_ <br />m <br />O <br />