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From: Armand Altaraz Fax: (BOO) 926-1963 Tp: Exee. Dir. Pf Community Fax: +17146672225 Paga 2 0/ 3 7/6/2011 12:41
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/Yrrv>
<br />1/5/2011
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGI-fT5 UPON THE CERTIFICATE HOLDER
<br />THIS
<br />.
<br />CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INS
<br />URER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the ce rtlflrate holder Is an ADDITIONAL INSURED, the pollcy(les) must he endorsed. H SUBROGATION IS WAIVED
<br />suhJect to
<br />,
<br />the terms and eondltlons of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certlfl cats holder In Ilea of such endorsement(s).
<br />PROpOCER NAMEA Certl fi cnto Deportment
<br />CHVignaC E AssOCi ate9
<br />950 H Street
<br />/-?
<br />Suite 1800 A/ PHONE FAx
<br />C No Esr: 619-239-6896 A/C No:619-239-8601
<br />,
<br />? ?O//_
<br />/O
<br />San Die ?(/ </
<br />g0, CA 92101-BOOS ESL
<br />ADDRESS: certificates@cavignac.com
<br /> . GAFCO-1
<br /> NSURER(3) AFFORDNG COVERAGE IVAIC>R
<br />NSURED
<br /> NSURER A
<br />Gaf con, Inc.
<br />701 H Street, Suite 1600 NsuRER B: WES TCHE TER FSRE 2NS CO 21121
<br />San Diego, CA 92101 United States NSURER C:
<br /> NSURER D
<br /> N3URER E
<br /> N3URER F
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER
<br />IOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIRE MENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC
<br />H THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL
<br />THE TERMS,
<br />EXG LUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />LITR TYPE OF INSURANCE POLICY EFF POLICY EJ[P
<br />POLICY NUMBER M,00/YVYY M/DD/YYYY
<br />LagIT3
<br />p? GENERAL LIABa.nl' 6808 957L952
<br />3/29/2010
<br />3/29/2011
<br />EACI-I OCCURRENCE
<br />$ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY PREP,115E5 Ea pml? rl® $ 1, 000, 000
<br /> CLAIMS-MADE XO OCCUR MED EXP (Ant orm Perk) $ 1 O, 000
<br /> X Contractual Liability X PERSONAL BADV INJURY 000
<br />000
<br />$ 1
<br /> X Separation of Insureds
<br />GENERAL AGGREGATE ,
<br />,
<br />$ 2
<br />000
<br />000
<br /> ,
<br />,
<br /> GENL ACC-,RELATE LIMIT APPLIES PER:
<br />? Fii000CT5 - COMP/OP AGG $ 2, 000, 000
<br /> POLICY X
<br />- LOG
<br />$
<br />A AUT OMOBILE LVIBILITY BAR 953L295 3/29/2010 3/29/2011
<br />COMBINED SINGLE LIM IT
<br /> $ 1, 000
<br />000
<br />
<br />X
<br />ANY AUTO p (Ea accder4) ,
<br />
<br />ALL OWNED AUTOS LSO is
<br />L BODILY INJURY (Par parsu?) $
<br />
<br />SCHEIXILED AUT 05 R Ca
<br />V£D r> BODILY INJURY (Per aGjdarY) $
<br />
<br />HIREp AIJt05 ?pR?
<br />
<br />(? PROPERTY DAMAGE
<br />
<br />(Par aGGdBnI) $
<br />
<br /> NON-OWNED AV TOS T
<br />S ?G?
<br />Y $
<br /> gA E- ?orc?e
<br /> t $
<br /> UMBRELLA LIAR
<br />OCCUR
<br />ASS1Sta?
<br />EACH OCCV RRENCE
<br />S
<br /> QCESS LIAB [.LAIMS-MADE
<br />AGGREGATE
<br />$
<br />
<br /> DEDUCTIBLE ?
<br />$
<br /> RETENTION $
<br />A VYORKEr23 COMPENSATION
<br />ANDEMPLOYERS' L1B667 gY905
<br />3/29/2010
<br />3/29/2011 X VYC STATU- OTH-
<br /> LIABILITY 1,/N T I
<br /> ANY pROPRIETOR/PARTNER/EXECI.rTI VE
<br />OFFl(FR/IOEMBER EXCLUDED? ?
<br />N/ A
<br />E.L. EACH ACCIDENT
<br />$ 1, 000, 000
<br /> (Mand?lory In NH)
<br />
<br />x yea, describe IrEar E.L. DISEASE - EA EMPLOY $ 1, 000, 000
<br /> DESCRIPTION OF OPERATIONS below E.L. OI^ ASE .POLICY LIMIT $ 1, 000, 000
<br />B Professional Liability 629121227 3/29/2010 3/29/2011 Each Claim $2,000,000
<br />Aggregate 52,000,000
<br />DE3CRIPnON OF OPERATON9 / LOr.ATONS /VEHICLES (Atlaclr ACORD 101, AdtllbnY Remark Scrreduta, K roars aprce la raglyrsy)
<br />Re: City Of Santa Ana. Additional Insured coverage applies t0 General Liability for City O£ Santa Ana, Agency
<br />its
<br />,
<br />officers, employees, agents, volunteers and representatives per policy form. Prof. Liab. - Claims made
<br />defense costs
<br />,
<br />included within limit.
<br />rcerr r.,-.?r? .??. .?'-.-.
<br />City of Santa Ana
<br />20 Civic Center Plaza (M-25) SHOULD ANY OF THE ABOVE DESG RIBED POLICIES BE CANCELLED BEFORE
<br />Santa Ana, CA 92702 THE EXPIRATON DATE THEREOF, NOTGE N111 LL BE DELIVERED IN
<br />United States ACCORDANCE VNTH THE POLICY PROVISIONS
<br />AUTH4i1ZED REPRESENTATIVE
<br />n r
<br />Jeffrey W. Cavignac ( ?'
<br />?.?..n,? „ ©1988-2009 ACORD CORPORATION. All ria Ms reserved
<br />•-----?---/ . r m .-...vrtv rranar ano Iogo era n3glaxenao merKS Of AL?VKLI Page 2 of 3
<br />EXIGIS - CAVIGNAC 6 ASSOCIATES 132373
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