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C I ie nt#: 394653
<br />RPLAURAI
<br />ACORD,. CERTIFICATE OF LIABILITY INSURANCE
<br />rDATE
<br />i12/201/20, 1YYY)
<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
<br />USI of Southern California SC
<br />PHONE AX
<br />949 790-9200 No):
<br />LiC # 0351162
<br />{A/Cs No, Ex1): (A/C,
<br />E-MAIL
<br />29A Technology Drive
<br />ADDRESS:
<br />t PRODUCER - -
<br />CA 92618
<br />CUSTOMER ID III:Irvine, _
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED INSURER A: Hanford Insurance Group
<br />A00048
<br />R.P. Linden S Associates Inc. INSURER B : Preferred Employers Ins Company
<br />10900
<br />Linden Avenue #200 Scottsdale Insurance Company
<br />INSURER c : P Y
<br />41297
<br />Lon
<br />Long Beach, CA 90807
<br />INSURER D :
<br />� INSURER E
<br />INSURER F
<br />COVERAGES CERTIFICATE NUMBER: REVISION NUMRER:
<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 />ILTR NSR
<br />TYPE OF INSURANCE
<br />DDL
<br />NVD SUBR
<br />POLICY NUMBER
<br />LICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DD/YYYY
<br />LIMITS
<br />A
<br />GENERAL
<br />LIABILITY
<br />X
<br />72SBACU6245
<br />02/11/2010
<br />02/11/2011
<br />EACH OCCURRENCE
<br />$1,000,000
<br />X
<br />PREMISES jEa qcc urrence)
<br />s300,000
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE I X I OCCUR
<br />MED EXP (Any one person)
<br />$10,000 _
<br />PERSONAL S ADV INJURY
<br />$1,000,000
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$2,000,000
<br />POLICY PRO LOC
<br />$
<br />A
<br />AUTOMOBILE
<br />LIABILITY
<br />X
<br />72.S'BACU6245
<br />2/11/2010
<br />02/11/2011
<br />LIMIT
<br />$1,000,000
<br />EOMaBIINtlEeDISINGLE
<br />ANY AUTO
<br />BODILY INJURY (Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />X
<br />HIRED AUTOS
<br />',
<br />((Perr accident
<br />$
<br />NON -OWNED AUTOS
<br />i
<br />X
<br />UMBRELLA LIAR
<br />OCCUR
<br />EACH OCCURRENCE
<br />$
<br />AGGREGATE
<br />$
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />.1 U t -_�
<br />'
<br />-
<br />DEDUCTIBLE
<br />— -_--
<br />$
<br />-$ _.
<br />�ti5151£t I]L �.--✓""'
<br />RETENTION
<br />B
<br />WORKERS COMPENSATION
<br />WKN1081971 O
<br />, O/O6/20, O
<br />10/06/2011
<br />X WC STATU- OTH-
<br />AND EMPLOYERS' LIABILITY Y / N
<br />TORY LIMITS. ER
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />E.L. EACH ACCIDENT
<br />$,,000,OOO
<br />OFFICER/MEMBER EXCLUDED? �
<br />N/A
<br />- ----- ---
<br />_ -
<br />(Mandatory in NH)
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />If yes, describe untler
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMIT
<br />$1 000 000
<br />C
<br />Prof Liability
<br />EKS3028791
<br />12/01/2010
<br />12/01/2011
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />The City of Santa Ana, its officers, agents, employees, consultants, special counsel, and representatives
<br />are named as additional insureds with respects to General Liability as per form SS00080405.
<br />CCK 1 IrICA 1 C KVLUEK
<br />CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Santa Ana
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Ron Ono;Parks, Recreation
<br />& Community Services
<br />AUTHORIZED REPRESENTATIVE
<br />26 Civic Center Plaza
<br />I Santa Ana. -GA 92701
<br />© 1988-2009 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD
<br />#S 5215385/M 5158277 J M WJ B
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