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____� <br />CONSO -2 OP I[]- EB <br />A�ORO CERTIFICATE OF LIABILITY INSURANCE <br />DATE(MM/DD/YYVY) <br />1 O /07H 1 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CE RT FICATE HOLDER - <br />IMPORTANT: If the cartkicate holder is an ADDITIONAL INSURED, the policy(ies) must ba 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 cartiTicata dose not confer rights to the <br />certificate holder in lieu of such endorsem ant s <br />PRODUCER 516�66�200 <br />Butwin Insurance Group - 516�66�213 <br />Suite 414 - - <br />60 Cutter Mill Road <br />Great Neck, NY 11021 X104 <br />HA°MME ^� <br />PNONE nx <br />iis� Ean: A/c No <br />+/AIL <br />ADDRE39: <br />INSURE 3 AFFORDING COVERAGE <br />NAIC i <br />Richard 5. Butwin � <br />_ <br />INtluRERA:The HarlTO rtl in 9Ufa nCe CO <br />34690 <br />INSVREO Untied Testing Corporation <br />dba United Testing Inspection <br />and Tasting <br />INSURER B : AIG <br />PREMISES Ea occvrena� <br />INSURERC:Admiral Insurance Com an <br />24556 <br />INSURER D <br />X <br />2262 GOIdenCfest DfIV9 <br />Suite 114 <br />12UE NOH1550 <br />DT/01/11 <br />Moreno Valley, CA 92553 <br />INSURER E <br />S 1 DrDD <br />INSURER F <br />S 1,000,00 <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. NOTW ffH STAN DING ANY REQUIREMENT. TERM OR CONOfTION OF ANY CONTRACT OR OTHER DOCUMENT WTi 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 CON OITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />ILTR <br />TYPE OF INSURANCE <br />POLICY NUMBER <br />MMIDDKYYY <br />MM/LDDNYYY <br />LIMBS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />S <br />•500,00 <br />PREMISES Ea occvrena� <br />S <br />A <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMSJAADE � OCCUR <br />X <br />12UE NOH1550 <br />DT/01/11 <br />07/01/12 <br />� MED EKP (Any one persen) <br />S 1 DrDD <br />PERSONAL BADV INJURY <br />S 1,000,00 <br />- <br />GENERAL AGGREGATE <br />{ 2,000,00 <br />GEN'L AGG REGATE LIM IT APPLIES PER'. <br />PRODUCTS- COMP /OP AGG <br />S 2. OOO.DO <br />POLICY X PRO- LOC <br />_ <br />� <br />r <br />AllTOYOBILE LIABILITY <br />CO a6 deDic INGLE LIMIT <br />5 1,000,0 <br />BODILY IN UJRYIPnr person) <br />$ <br />A <br />X ANY AU rO <br />12UENOH1551 <br />07/01!11 <br />07/01/12 <br />A,J_ OVVNED SCHEDULED <br />AUTOS AUTOS <br />- - - <br />BODILY INJURY IPer aCCltl anq <br />S <br />HIREDAUTOS AUTOS�vED <br />PeOra¢tlent AM E <br />'S <br />i <br />�( <br />UMBRELLA LIAB <br />X <br />OCCUR <br />EACH OCCURRENCE <br />S 6,000,0 <br />AGGREGATE <br />S 5.OD0.0 <br />g <br />E %LESS LIAa <br />cLArns+�nAnE <br />BE060609017 <br />OT /D1 /i i <br />07/01/12 <br />DED X RETENTION 10000 <br />S <br />A <br />WORKERS COMPENSATON <br />AND EMPLOYERS' LWHILITY �, / N <br />ANY PROPRIETORIPARTNER,E>�CUT VE <br />OFFICERIMEMBER EXCLUDED9 � <br />(Mandatory In NH) <br />N/A <br />12W EOH1549 - - <br />OT /D1 /11 <br />OT /01/12 <br />X VVC STATU- OTH- <br />� <br />EL. EACH ACCIDENT <br />S i.OD0.00 <br />E.L. DISEASE - EA EMPLOYEE <br />i 1,000,OD <br />DE6CRw TION OF OPERATIONS WIPV <br />- <br />EL DISEASE - POLICY LIMB <br />S t.DOO,OO <br />C <br />Professional Liab <br />E000001416201 <br />07/01/11 <br />07/01/12 <br />'Ea Claim z,o00,00 <br />R etro Date 9/1/96 <br />Aggregate 2,000,00 <br />DESCRIPTION OF OPERATON9 / LOCATONS / VENDEE$ (Anacn ACORD 101, pddltlonAl R�marka ScM1pdW�, Ir mores apace li r�qulrs d) <br />City of Santa Ana Is an addklonal Insured <br />APPROVED AS TO FORM <br />% <br />_ <br />CERTIFICATE HOLDER - 'uT t Altorn- _vCANGELLATION <br />clT�rsAA <br />9HOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTCE WILL BE DEWERED IN <br />� City Of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. <br />P.O. Box 1968, M -22 - <br />Santa Ana, CA 92702 AurHOwzED REPRESENiArnE <br />® 19H8 -2010 ACORD CORPORATION_ Alf rights reserved. <br />ACORD 25 (2010N6) - The ACORD name and logo are replstered marks of ACORD <br />