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- OP ID- KG <br />_ <br />DATE(MM/DDMYY) <br />CERTIFICATE OF LIABILITY INSURANCE F10/25/10 <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 WAIVEDsubject 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 909-886-9861 <br />Alllant Insurance Services,lnc 909-886-2013 <br />(Lic-OC36861) <br />735 Carnegie Drive, Ste 200 <br />San Bernardino, CA 92408 <br />CONTACT <br />N E: Karen Adcock <br />P NE -- FA <br />LAIC. Ne. EXU: 909-474-8768 ac Ne 909-886-2013 <br />EalA,a -- <br />ADDRESS: kadcock alliantinsurance.com <br />PRODUCER ,. L <br />CUSTOMER ID #: LAJIg-1 <br />INSURERS AFFORDING COVERAGE NAIC # <br />Scott. <br />INSURED La Jolla Institute <br />INSURER A; Hartford Casualty Insurance Co <br />10373 Trademark Street Suite C <br />Rancho Cucamonga, CA 91730 <br />INSURER B: <br />INSURER C: <br />INSURER D: <br />EACH OCCURRENCE $ 2,000,00 <br />INSURER E: <br />X COMMERCIAL GENERALLIABILITY <br />CLAIMS -MADE FX OCCUR <br />X <br />INSURER F: <br />COVERAGES CERTIFICATE NUMBER: RFVICInN NI InenFR: <br />THIS IS TOCERTIFY 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 />LNTR <br />TYPE OF INSURANCEADDL <br />UBR <br />POLICY NUMBER <br />-EFF <br />MM DDYM/W <br />Pa ICY EXP <br />MM OD/YYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE $ 2,000,00 <br />A <br />X COMMERCIAL GENERALLIABILITY <br />CLAIMS -MADE FX OCCUR <br />X <br />72SBAUV9751DX <br />11/06/10 <br />11/06/11 <br />AMA REN <br />PREMISES occurrence $ 300,00 <br />MED EXP (Any,y one person) $ 10,00 <br />PERSONAL S ADV INJURY $ 2,000,00 <br />GENERAL AGGREGATE $ 4,000,00 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />PRODUCTS - COMP/OP AGG $ 4,000,00 <br />POLICY PRO- LOC <br />S <br />AUTOMOBILE <br />LIABILITY <br />ANY AUTO <br />COMBINED SINGLE LIMIT <br />(Ea accident) $ <br />BODILY INJURY (Per person) $ <br />ALL OWNED AUTOS <br />BODILY INJURY (Per accident) $ <br />SCHEDULED AUTOS <br />PROPERTY DAMAGE $ <br />(Per accident) <br />A <br />X <br />HIRED AUTOS <br />72SBAUV9751 DX <br />11/06/10 <br />11/06/11 <br />A <br />X <br />NON -OWNED AUTOS <br />72SBAUV9751 PX <br />11/06110 <br />11//06111 0� <br />11/06/11 <br />$ <br />O <br />!t V !t/ 0 <br />$ <br />UMBRELLA LIAR <br />OCCUR <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br />EXCESS LIAR <br />CLAIMS -MADE <br />DEDUCTIBLE <br />$ <br />1 `. I. I' <br />"f <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION <br />WC STATU- -IH- <br />AND EMPLOYERS' LIABILITY YIN <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED, <br />NIA <br />C <br />A <br />R <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE - EA EMPLOYEE $ <br />(Mandatory In NH) <br />IT yes, tlescnbe under <br />E.L. DISEASE -POLICY LIMIT $ <br />DESCRIPTION OF OPERATIONS below <br />A <br />Property <br />72SBAUV9751DX <br />11/06/10 <br />11/06/11 <br />Sae Below If Applie <br />DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach !CORD 101, Additional Remarks Schedule, if mora apace is required) <br />Certificate holder is additional insured. - <br />�.crc I Ir l�.rt I c nv�u cic GANGtLLA l ILJN <br />CITYSAO <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br />© 1988-2009 ACORD CORPORATION. All riahts reserved. <br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD <br />