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<br />111I RO CERTIFICATE OF LIABILITY INSURANCE11/10/2011
<br />DATE
<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 CONSTITaUTF P,.%ONT1ZACT,BETV1i[E N 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 statementorl this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />'--ME:
<br />NANTACT
<br />Amy Alberding / Denise Bailey
<br />SPIB Insurance Agency, Inc.
<br />License Number 0719264
<br />a/c No Ext: (949) 582-5220 (A/C No): (949)582-3512
<br />E-MADDRESS: amY@spib. corn / Deni-se@spib.com
<br />26441 Crown Valle Parkwa #200
<br />Y Y
<br />PRODUCER 00000369
<br />CUSTOMER ID,
<br />Mission Viejo CA 92691
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC#
<br />INSURED
<br />INSURER A:Peerless Insurance Co
<br />4198 GE
<br />INSURERB:The Netherlands Insurance Co
<br />4171 GE
<br />Rue Vac Property Services Inc.
<br />600 W. Taft Avenue
<br />INSURERc:Golden Eagle Insurance Co
<br />10836 GE
<br />INSURERD:AIG/Granite State Ins. Co.
<br />averick
<br />INSURER E:
<br />INSURER F:
<br />Orange CA 92865
<br />COVERAGES CERTIFICATE NUMBER:MSTR2011-12 GL-A-U-P-WC REVISION NUMBER'
<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 />INSR i TYPE OF INSURANCE
<br />LTR
<br />ADDL
<br />INSR
<br />SUBR
<br />WVD'
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DD(YYYY
<br />POLICY EXP
<br />MMIDDIYYY
<br />j
<br />LIMITS
<br />'. GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />AMA TO HEN I ED_
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />A CLAIMS -MADE F OCCUR
<br />BP 9558563
<br />/1/2011
<br />/1/2012
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY JPRO- LOC
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE LIMIT
<br />x
<br />ANY AUTO
<br />I
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ALL OWNED AUTOS
<br />A 9797086
<br />/1/2011
<br />/1/2012
<br />BODILY INJURY (Per accident)
<br />$
<br />'
<br />SCHEDULED AUTOS
<br />PROPERTY DAMAGE
<br />$
<br />X
<br />HIRED AUTOS
<br />(Per accident)
<br />X
<br />NON -OWNED AUTOS
<br />-
<br />Underinsured motorist property
<br />$
<br />Medical payments
<br />$
<br />X
<br />UMBRELLA LIAB X OCCUR
<br />(n n
<br />/
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />EXCESS LIAB CLAIMS -MADE.
<br />AGGREGATE
<br />$ 1,000,000
<br />DEDUCTIBLE
<br />C
<br />RETENTION $
<br />U9558863 f
<br />2/1/2011
<br />/1/2012
<br />$
<br />D WORKERS COMPENSATION
<br />TU- OTH-',
<br />AND EMPLOYERS' LIABILITY YIN
<br />XMIT FIR
<br />�.AH
<br />ECIDENT
<br />$ 1 .000.000
<br />ANY PRCPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/M EMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE - EA EMPLOYE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />C005643392 '1/1/2011
<br />/1/2012
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />E.L. DISEASE - POLICY LIMB
<br />$ 1 000,000
<br />A PROPERTY - SPECIAL FORM
<br />BP 9558563
<br />/1/2011
<br />/1/2012
<br />BUILDING 1,224,000
<br />REPL COST $1, 000 DED
<br />BUSINESS PER PROPERTY 102,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
<br />RE: SANTA ANA REGIONAL TRANSPORTATION CENTER.
<br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE NAMED AS ADDITIONAL
<br />INSUREDS WITH RESPECT TO GENERAL LIABILITY PER FORM GECG 602 0904. *CANCELLATION PER POLICY PROVISIONS, COMPANY FORM
<br />IL0270 11/04 PAGE 2 OF 4- # 7 B 1 & 2 ATTACHED.
<br />CITY OF SANTA ANA
<br />PUBLIC WORKS AGENCY/SARTC
<br />20 CIVIC CENTER PLAZA, M-21
<br />SANTA ANA, CA 92701
<br />IY IiCLLM 1IV
<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 />Hines, CPCU ARM CLU+Sr� — —
<br />u 7988-2UU9 ACORD CORPORATION. All rights reserved.
<br />INS026 (2oosos) The ACORD name and logo are registered marks of ACORD
<br />
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