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'4� °R °® CERTIFICATE OF LIABILITY INSURANCE ��iYs loll YY' <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, AN)Y"fHE4SERT1 PtCATB. HOLDEFj. <br />IMPORTANT: If the certificate holder is an ADDITIOf�AL INSUR D; a 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 endor�errlent(s <br />PRODUCER +�" �. <br />NAME: Mike MCCOy <br />Pearl Insurence -_ <br />PNONE 866- 679 -0802 FAX 866- 559 -3091 <br />A/C No <br />'1200 E. Glen Avenue <br />ADDRIESS: Mike.McCo Pearllnsurance.com <br />Peoria Heights, IL 6'16'16 <br />INSURE S AFFORDING COVERAGE <br />NAIC # <br />4030800732 <br />INSURER A : Velley FOrge Insurance Company <br />20508 <br />EACH OCCURRENCE <br />INSURED <br />INSURER B : Continental CiasYalty Company <br />2D443 <br />Albert Grover 8: Associates, Inc. <br />INSURER c : American Cas. Co. of Raadln PA <br />20427 <br />211 Imperial Hwy, Suites 208 <br />Fullerton, CA 9283$ -1047 <br />INSURER D <br />PERSONAL &ADV INJVRY <br />$ 'I,000,OOO <br />INSURER E <br />GENERAL AGGREGATE <br />INSURER F <br />COVERAGES CERTIFICATE NUMBER: 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 REOUIREM ENT, 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 />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MM/DDrYYW <br />POLICY EXP <br />MM/DD/YYYY <br />LIMITS <br />A <br />GENERAL LIABILITY <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE � OCCUR <br />X <br />X <br />4030800732 <br />07/01 /11 <br />07/01 /12 <br />EACH OCCURRENCE <br />$ � �������� <br />DAMA E T RENTED <br />PREMISES Ea occurtance <br />$ 7,00�,�0� <br />MED EXP (Any one parson) <br />$ 1 D,OOD <br />X Primary /Non COntributary <br />PERSONAL &ADV INJVRY <br />$ 'I,000,OOO <br />GENERAL AGGREGATE <br />$ 2,000,000 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP /OP AGG <br />S 2,000 +��� <br />X POLICY PRO LOC <br />$ <br />A <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />HIRED AUTOS X AUTOSwNED <br />4030800732 <br />Included In GL y <br />PeliC <br />Hired Auto Phy sical Dames e <br />Deductible: S25D g <br />07/07/71 <br />07/0'1 /72 <br />COMBINED SINGLE LIMIT <br />Ea accident <br />'1,000,000 <br />BODILY INJURY (Par person) <br />$ <br />BODILY INJURY Per eccitlent <br />( ) <br />S <br />x <br />PaOr accitlentDAMAGE <br />$ <br />B <br />X <br />UMBRELLA LIAR <br />X <br />OCCUR <br />403060'1783 <br />07/01 /11 <br />07/01M 2 <br />EACH OCCURRENCE <br />$ 2,000,000 <br />AGGREGATE <br />$ 2,000,000 <br />EXCESS LIAB <br />CLAIMS -MADE <br />EXCIYd @8 Professional <br />Liability <br />DED RETENTION $ <br />$ <br />C <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />ANY PROPRIETOR/PARTN ER /EXECUTIVE Y/ N <br />OFFICER /MEMBER EXCLU DED7 � <br />(ManCatory In NH) <br />IT yes, tlescribe untler <br />DESCRIPTION bF OPERATIONS below <br />N / p` <br />%� <br />430800780 <br />Blanket Waiver of Subrogation <br />Endt WC00031 3 <br />07/0'1M1 <br />07/0'1 /12 <br />X NVC STATU- OTH- <br />$ 1,000,OOO <br />E.L. EACH ACCIDENT <br />E.L. DISEASE - EA EMPLOYE <br />$ '1,000,000 <br />E.L. DISEASE - POLICY LIMIT <br />$ 1,O��,�DD <br />B <br />Professional Liability <br />MGA2883544$$ <br />07/0'1 /11 <br />07/0'1 /72 <br />2,000,000 each claim <br />Claims Made <br />APp <br />U V �JU <br />54,0�0� 00 aggregate <br />$' d�Jaaa e <br />� � � iC <br />DESCRIPTION OF OPERATONS /LOCATIONS /VEHICLES (Attach ACORD 10�, Addltlonal Ramarlea Schedule, Ir more apace Is raqulned) <br />Civil /Transportation/Traffic Engineering Firm <br />�.. <br />RE: 2010 Citywide Engineering and TrafTC Survey aura Stat She dy <br />Assistant City Attorney <br />Excluded officer Albert Grover from the above Workers Compensation Policy <br />liCrt I It -It..A 1 C tIVLUCR GANGC LLA l IVN <br />City Of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />20 Civic Center Plaza, M-43 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />Santa Ana CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORD'ED REPRESENTATVE <br />� � ��--� <br />© 1988 -2010 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD <br />