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ACORO CERTIFICATE OF LIABILITY INSURANCE
<br />DATE <MM,DD/YVYY>
<br />3/1/2012
<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_ 1 r p - 33
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ie 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 cert1ficate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s). I-. c - I r, 1 ;.�'.
<br />PRODUCER
<br />NAMEAC "Alberdi Dg
<br />SPIB Insurance Agency, Inc.
<br />License Number 073.9264
<br />PHONE "�g49) b62-5220 FAX (g49)582-3512
<br />A/C No
<br />aDORIEss: amy@spib. Com
<br />26441 Crown Va11ey Parkway#200
<br />QU�PROT UCERI 00000369
<br />M'L5510n Vie O CA 92691
<br />INSURER 5 AFFORDING COVERAGE
<br />NAICs
<br />INSURED
<br />e
<br />INSURERA: PerleSS Insurance CC,
<br />24198 CIE
<br />INSURERB:The Netherlands Insurance Co
<br />24171 G
<br />Rue Vac Property Services Inc
<br />600 W. Ta£t Avenue 1,,19�%
<br />o+ v/, `O�/
<br />INSURER c:Golden Ea 1e Insurance Co
<br />10836 G
<br />INSURER D:
<br />INSURER E. _-
<br />- -. _._
<br />/1 "
<br />Orange CA 92865 �/d" ` O
<br />----- -- ---------
<br />INSURER F .
<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
<br />LTR
<br />TYPE OF INSURANCE
<br />INrRyyyp
<br />POLICY NUMBER
<br />MIWDD%YYY
<br />MMIOO"EWY
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE
<br />$ 1 , 000 , OOO
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE� OCCUR
<br />BP9558563
<br />/1/2012
<br />/1/2013
<br />PREMISES occurrence
<br />$ 10,000
<br />MED EXP (An.yy one person)
<br />, 000
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$ 1 , OOO , 000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN-L AGGREGATE
<br />LIMIT APPLIES PER:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />X POLICY
<br />PRO -
<br />CT LOC
<br />$
<br />AUTOMOBILE
<br />X
<br />LIABILITY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1 , 000 , 000
<br />BODILY INJURY (Per person)
<br />$
<br />B
<br />ALL OWNED AUTOS
<br />9797086
<br />/1/2012
<br />/1/2013
<br />BODILY INJURY (Par accident)
<br />$
<br />SCHEDULED AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />(Par accident)
<br />$
<br />HIRED AUTOS
<br />X
<br />NON -OWNED AUTOS
<br />Underin ,u I motorist property
<br />$
<br />Medical payments
<br />$
<br />C
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 1 , 000 , 000
<br />][
<br />AGGREGATE
<br />$ _1, 000 , OOO
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />U955B863
<br />DEDUCTIBLE
<br />$
<br />RETENTION $
<br />/1/2012
<br />/1/2013
<br />WORKERS COMPENSATION
<br />WC STATUS O
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
<br />OFFICER/MEMBER EXCLUDED?
<br />NIA
<br />SEE SCIP CERT
<br />R
<br />EL EACH ACCIDENT
<br />$
<br />E.L. DISEASE - EA EMPLOYE
<br />$
<br />(Mandatory in NH)
<br />IT yyes, describe under
<br />DESCRI,MI OF OPERATIONS Fcloiv
<br />E.L. DISEASE -POLICY LIMIT
<br />$
<br />A
<br />PROPERTY , SPECIAL FORM
<br />BP9558563
<br />/1/2012
<br />/1/2013
<br />BUILDING 1,248,480
<br />REPL COST$iOOO DED
<br />BUS. PERSONAL PROPERTY 104 , 000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Addlti onal Rem MS Schedule, If more apace Ia required)
<br />RE: SANTA ANA REGIONAL TRANSPORTATION CENTER, 1000 E_ SANTA ANA- BLVD., SANTA ANA, CA.
<br />THE CITY OP SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND RESPRESENTATZVE9 ARE NAMED AS ADDITIONAL
<br />INSUREDS WITH RESPECT• TO GENERAL LIABILITY AS PER COMPANY FORM GECG 602 (09/04) SECTION V, A & B. PRIMARY AND
<br />NON-CONTRIBUTORY WORDING IS PROVIDED IN FORM # 22-111 01/07.
<br />I.0 Ir II C r Luc:m ' .. " -1 -" ' — ., ✓ n N
<br />TFIE CITY OF, SANTA
<br />20 CIVIC CENTER PIAZAA,-.I,(n
<br />SANTA ANA, CA 92701
<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 />t,
<br />'L Hines , CPCU ARM CLU PC�+�� aL lr•�i�r I -4 '
<br />ACORD 25 (2009109) © 1988-2009 ACORD CORPORATION. All rights reseryed.
<br />INS025 (mo909) The ACORD name and logo are registered marks of ACORD
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