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-? ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 06/14/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Insurance Services West, Inc. PHONE FAX Seattle WA Office (206) 749-4800 (206) 749-4860 (A/C. No. Ext): A/C. No.): 1420 Fifth Avenue E-MAIL Suite 1200 ADDRESS: Seattle WA 98101-4030 USA INSURER(S) AFFORDING COVERAGE NAIC 1t INSURED INSURER A: XL Specialty Insurance CO 37885 T-Mobile USA, Inc INSURER B: Greenwich Insurance Company 22322 its subsidiaries and Affiliates 12920 SE 38th street INSURER C: National Union Fire Ins Co of Pittsburgh 19445 Bellevue WA 98006 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: b/UU4bb4b913 REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MMIDDfYYY)G LIMITS B GENERAL LIABILITY RGD EACH OCCURRENCE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY PR AGES Ea occurrence $1, 000' 000 CLAIMS-MADE X? OCCUR MED EXP (Any one person) S5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 POLICY PRO X LOC IECT B AUTOMOBILE LIABILITY RAD 500025701 05/01/2512 05/01/2013 COMBINED SINGLE LIMIT $2 000 000 AOS Ea accident , , B X ANY AUTO RAD 500025801 05/01/2012 05/01/2013 BODILY INJURY ( Per person) ALL OWNED AUTOS SCHEDULED AUTOS MA BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident C X UMBRELLA LIAB X OCCUR 13273159 05/01/2012 05/01/2013 EACH OCCURRENCE $5,000,000 SIR applies per policy ter ns & condit ions EXCESS LIAB CLAIMS-MADE AGGREGATE S5,000,000 DED X RETENTION A WORKERS COMPENSATION AND RWD5000301 05/01/2012 05/01/2013 X WC STATU- OTH- EMPLOYERS' LIABILITY Y / N AOS TORY LIMITS ER A ANY PROPRIETOR I PARTNER / EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A RWR5000302 05/01/2012 05/01/2013 E.L. EACH ACCIDENT $1,000,000 (Mandatory in NH) If es describe under wI E.L. DISEASE-EA EMPLOYEE $1,000,000 , DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) The Certificate Holder and other entities as defined if required by written contract" are Additional Insured for General Liability and Automobile Liability solely as respect to operations of the Named Insured at the above location if required by contract. A waiver of Subrogation is granted in favor of certificate Holder as required by written contract but limited to the operations of the insured under said contract, with respect to the General Liability and Automobile Liability policy. General Liability and Automobile Liability evidenced herein is Primary and Non-Contributory to other insurance available to the certificate Holder b t l t th t t i d b i i , u on y o e ex en requ re y wr tten contract w th the insured. Per Cancellation Notification to others Endorsement - In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, CERTIFICATE HOLDER CANCELLATION ..,! / J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa And AUTHORIZED REPRESENTATIVE Santa Ana City Fire Department. - Santa Ana CA 92707 USA 14 6 'X'WWXM yrill'/t4MSd X"XI v M J m :r c m 'O m 9 O 2 rh r-- 0) U) CC) O rr) LO O Z dt V li. 1: m 0 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD