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Policy Number: Date Entered: 03/09/1011 AeC) a CERTIFICATE OF LIABILITY INSURANCE ATE(iMI O(i rn 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 poll(:y(les) 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 Iieu of such endorsement (s). PRODUCE' Dalati,a Insurance, Inc. 791 S. BROOiCF1DRST ST ANAHEIM, CA 92804 " " ,Am N . (714)956 -1312 FAX (714)956 -x434 E -MAIL dalatiinsuranceaQmail.com INSURER(S) AFFORDING COVERAGE NAIL f INSURER A: ACE INSURED AiCSCO 17782 GEORGETOWN LN HUNTINGTON BEACH, CA 91647 INWRER B: INSURER C : EACHOCCURRENCE INSURER O: h r INSURER 6: MED EXP one on) INSURER F: PERSONAL& AOV INJURY COVERAGES CERTIFICATE NUMBER: 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 POUCIe$. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPO OF INSURANCE vim POLICY NUMBER LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE FI OCCUR EACHOCCURRENCE 5 - h r $ MED EXP one on) $ PERSONAL& AOV INJURY S GENERAL.AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER POLICY PR CT LOC PRODUCTS - OOMPIOP AGG S S. AUTOMOBILE LIA &CITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS K "� HIRED AUTOS AU APPROVED AS t �. h ineedy TO FORM WWNED SINGLE Lim I BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY (Per a needy S UMBRELLA LIAR EXCESS UAB HCLAIMS-MADE OCCUR Assistant City ALttorney EACH OCCURRENCE $ AGGREGATE S DED RETENTION S L 5 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOMPARTNEWEXECUIVE YIN OFFICERIMEMBEREXCLUDED7 (MendmM III NH) I! yes, dWCObe r. der of RIPTION OF OPERATION ow NIA 045757705 4/11/2010 4 /11/]011 I W ATU- E.L.EACHAOCCENT 1,000,000 EL.DISEASE- EAEMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $11"01000 DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ANech ACORD 101, Addleenel n n wke Sche"s. N more *Pees Y reerd CITY O! SANTA ANA I8 NANBD AS ADDITIONAL. INSURED WITH RESPECT TO THE INSUREDS OPERATION. 30 DAY NOTICE CANCELLATION 10 DAY rOR NON- PAYKIINT OF PRRNIUM CITY Or SANTA Am PUBLIC WORKS AGENCY is -22 PO Box 1988 SANTA ANA, CA 92702 ACORD 26 (2010/06) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOL, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLIC')�PFiOVI�IONS. AUTHORUZED REPRESENTATIVE/ 0 1988 The ACORD name and logo are registered marks of Produced uslrV Forms Boer Plug saMwere. www.FonnsBow.aoln; kWesene Publish" 500.208.1977 All rights reserved.