|
'4` °R°® CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/V
<br />9/28/2010 0
<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 NAME: `Tulie Traughber
<br />GLENDALE INSURANCE AGENCY, INC. (A1CC,No,Ex1): (818)244 -1144 �(A/C, No):- (818)242 -5288
<br />750 FAIRMONT AVENUE, SUITE 100 ADDRRESS:]ulie@glendaleins.com
<br />-_ -
<br />P. O. BOX 831 PRODUCER 00001994
<br />CUSTOMER ID #:
<br />GLENDALE CA 91209 -0831 INSURER_(S) AFFORDING COVERAGE NAIC#
<br />INSURED wCompany _ -
<br />suRERA.Peerless Insurance j19690
<br />Phoenix Group Information Systems INSURER B:Am_erican States Ins. Co. 119704
<br />INSURERC:Capital Specialty Ins. Corp.. 10328
<br />77 North Main Street, Suite 400 INSURERD:National Union Fire Ins. Co. ;19445
<br />INSURER E: _
<br />Santa Ana CA 92705 INSURER F:
<br />COVERAGES CFRTIPIr_ATr- IUI IIUIIQI= .CT.1 nwiRni al 7
<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.
<br />-
<br />- -- -- - - _ [ADDL SUBR'
<br />INSR
<br />LTR TYPE OF INSURANCE POLICY EFF - POLICY EXP
<br />R' D POLICY NUMBER MM /DD/YYYY MM /DD/YYYY LIMITS
<br />- GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X CO
<br />COMMERCIAL GENERAL LIABILITY
<br />DAMAGE TO RENTED
<br />100,000
<br />PREMISES _(Ea occurrence)
<br />$
<br />A
<br />CLAIMS -MADE X OCCUR X X CBP4653343
<br />.10/1/2010
<br />10/1/2011
<br />MED EXP (Any one person)
<br />_
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 11000,000
<br />--
<br />GENERAL AGGREGATE
<br />$ 2, 000_,_000
<br />AGGREGATE LIMIT APPLIES PER:
<br />X 1 -
<br />(
<br />PRODUCTS - COMP /OP AGG
<br />$ 2,000,000
<br />PRO -
<br />PO LICY I LOC
<br />- — -- -
<br />$
<br />AUTOMOBILE LIABILITY I
<br />COMBINED SINGLE LIMIT
<br />$ 11000,000
<br />ANY AUTO � 'i II
<br />� (Ea accident)
<br />A ALL OWNED AUTOS CBP46 53343 10 /1/2010 110/1/2011
<br />I BODILY INJURY (Per person)
<br />- -- -
<br />$
<br />SCHEDULED AUTOS
<br />BODILY INJURY (Per accident)'
<br />$
<br />♦` ���� m W�
<br />X ff. � KOM �
<br />HIRED AUTOS
<br />'� PROPERTY DAMAGE
<br />$
<br />X NON -OWNED AUTOS
<br />(Per accident)
<br />$
<br />i
<br />$
<br />UMBRELLA LIAR !OCCUR '.
<br />E XCESS LIAB
<br />CLAIMS - MADE' -"_
<br />EACH OCCURRENCE', $
<br />1
<br />ill
<br />City
<br />DEDUCTIBLE Dqpoy Cif A�
<br />_AGGREGATE $
<br />.v
<br />$
<br />RETENTION $
<br />1$
<br />B WORKERS COMPENSATION X 01WC1061605 10/1/2010 110/1/2011
<br />][ WCST TU- �OT ER
<br />Y/N
<br />OFFICER/MEMBER XCLUDE EXECUTIVE
<br />EXCLUDED? ❑ N/A:
<br />E.L. ACH ACCIDENT $ 1,000,000
<br />(Mandatory In H)
<br />in
<br />. - _.
<br />If yes, describe under
<br />E. L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />-_
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />C Errors & Omissions Liab. iSGCO174701 10/1/2010 Ii10 /1/2011 1
<br />$2,500 deductible 1,000,000
<br />D Crime Coverage 011891544 10/1/2010 '10/1/2011
<br />$25,000 deductible 1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />It is agreed that the City of Santa Ana, its officers, employees, agents, volunteers and representatives are named
<br />Additional Insureds per form GECG602 (09/04) attached. It is also agreed that this insurance is primary and
<br />non - contributory.
<br />City of Santa Ana
<br />Attention: Yolanda BQtAA
<br />60 Civic Center Plaza
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Traughber /0134
<br />-- --- -" 0 1988-2009 ACORD CORPORATION. All rights reserved.
<br />INS025 (20090x9) The ACORD name and logo are registered marks of ACORD
<br />
|